HUNGER S IMPACT ON HEALTH AND WELL-BEING

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2 HUNGER S IMPACT ON HEALTH AND WELL-BEING

3 Hungers Impact on Health & Well-being Sandra Hoyt Stenmark M.D. Sarah Van Scoy M.D.

4 Agenda Hunger is prevalent Hunger impacts diet quality Hunger impacts health outcomes Hunger screening and referral optimizes care

5 Hunger by Household Characteristic Source: Household Food Security in the United States in 2013, ERR-173 Economic Research Service/USDA

6 Too Many Must Choose to Treat or Eat One third of U.S. adults with chronic illness cannot afford food, medicine or both Source: Berkowitz: The American Journal of Medicine (2014) 127,

7 Food Insecurity is Associated with Poorer Nutritional Quality Fewer vegetables, fruit and dairy products Lower intake of calcium, magnesium, zinc, vitamins A and B-6 Source: Am J Clin Nutr Aug;100(2):684-92

8 Food Insecurity is Associated with Poorer Health Outcomes Diabetes, cardiovascular disease and obesity Iron deficiency Mental illness: anxiety, depression and stress Developmental delays, inability to focus Irritability and decreased social functioning Source: Weinreb, Pediatrics 2002;110 (4). & Seligman, NEJM 2010, Jul;363 (1)

9 Hunger Impacts Begin In Utero As adults children who were born during the Dutch famine had increase prevalence of: Obesity Diabetes High Blood Pressure Cardiovascular Disease Source: Roseboom, Molecular & Cellular Endocrinology 2001; 185: 93-98

10 Hunger is an Adverse Childhood Experience Intimate Partner Violence Abuse- physical, mental, sexual Neglect Parental substance abuse Household mental illness Household incarceration Hunger Extreme Poverty Shonokoff, Pediatrics, 2012

11 ACE Scores Predicts Graded Increase in: Heart disease Chronic obstructive pulmonary disease Alcoholism and drug abuse Fetal death Depression Suicide attempts Risk for intimate partner violence Multiple sexual partners Sexually transmitted diseases Unintended pregnancies Adolescent pregnancy

12 Health Outcomes and Brain Development are a Result of Too Much Unbuffered Stress impaired immune functioning chronic illness reduction in neuronal connections altered brain function and architecture developmental and cognitive deficiencies

13 Hunger Screening and Referral Optimizes Health and Well-Being In the past 3 months have you worried whether your food would run out before you had money to buy more?

14 Screening for Hunger in Clinics in 2011

15 Screening at Kaiser Permanente Implement screening Pediatrics Registered Dietitians Seniors - Total Health Assessment Obstetrics New Members Chronic care nurses - depression, diabetes Referral: outreach increased connection from 5% 78%

16 Development Behavior Growth Hunger Red Flags

17 Food Stamps as Medicine

18 Call to Action Increase awareness of hunger prevalence and the health/educational impacts Screen Connect to all available nutrition programs and resources Advocate for programs and policies to eliminate hunger, improve health and educational outcomes

19 Thank you

20 Focusing on children: Nutrition assistance in Colorado Tracy Miller, MSPH, RD Acting Nutrition Services Branch Chief Section Manager, Child and Adult Care Food Program Colorado Department of Public Health & Environment

21 Colorado Department of Public Health & Environment Nutrition Services Branch Child and Adult Care Food Program (CACFP) Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

22 Uniquely positioned for impact Economic stability Health WIC CACFP Food security School readiness

23 Health Impact CACFP participation Reduced likelihood of underweight among low income children 1,2 Less risk of overweight 1,2 Moderate increase in consumption of milk and vegetables 2 WIC Participation Less likely to be underweight 3 Less risk of short stature 3 Less likely to have perceived poor or fair health 3 Cognitive & academic benefit 4 Fewer family stressors related to child health risks 5 Better use of health care than non-wic Medicaid enrolled children 6

24 Food Security & Economic Impact CACFP 4% reduction in household food insecurity 1 Reduction in child care costs Contributes to quality early childhood experiences WIC 5.5 percentage point reduction in child food insecurity percentage point reduction in very low child food security 7

25 Today s trends in participation CACFP Currently serves 4 million on average daily in the US Participation has increased by 9% since 2011 WIC Increased steadily to 8.9 million in 2011 in the US Since 2011 participation has dropped by 5% In Colorado, CACFP participation has been fairly stable with recent increases to about 45,000 participants served on average each day In Colorado, current participation is near 90,700, which is a 19% decline since Colorado data shows leveling of this trend Today s focus: program quality & outreach

26 How we all work together Make families aware of all resources Community Food Access Points CACFP WIC SNAP Summer Food Service Program

27 How we all work together Not just food HEALTHY FOOD! Provide access to healthy food Provide consistent nutrition messaging

28 References 1. Gordon R, Kaestner R, Korenman S, Abner K. The Child and Adult Care Food Program: Who is Served and what are Their Nutritional Outcomes? NBER Working Paper Korenman S, Abner KS, Kaestner R, Gordon RA. The Child and Adult Care Food Program and the nutrition of preschoolers. Early Childhood Research Quarterly. 2013; 28(2): Black MM, Cutts DB, Frank DA, et al. Special Supplement Nutrition Program for Women, Infants, and Children participation and infants growth and health: a multisite surveillance study. Pediatrics. 2004; 114: Jackson M. Early childhood WIC participation, cognitive development and academic achievement. Social Science and Medicine. 2015; 126: Black MM, Quigg AM, Cook J, et al. WIC participation and attenuation of stress-related child health risks of household food insecurity and caregiver depressive symptoms. Archives of Pediatric & Adolescent Medicine. 2012; 166(5): Buescher PA, Horton SJ, Devaney BL, et al. Child participation in WIC: Medicaid costs and use of health care services. American Journal of Public Health. 2003; 93(1): Kreider P, Pepper J, Roy M. Identifying the Effect of WIC on Very Low Food Security among Infants and Children. University of Kentucky Center for Poverty Research Discussion Paper Series, DP

29 Thank you! Tracy Miller

30 HUNGER IS A SERIOUS AND OFTEN INVISIBLE PROBLEM IN COLORADO, BUT IT IS SOLVABLE. THANK YOU FOR TAKING A STAND and attending the Hungry for Change Summit!