Ensuring Equity and Access in Food Is Medicine

The U.S. Department of Health and Human Services (HHS) is committed to addressing health disparities and advancing health equity by expanding access to care, improving health care quality, and supporting health care providers who serve populations who are at increased risk for poor health outcomes.  

In recognition of research findings that social determinants of health (SDOH) account for about half of the variation in health outcomes in the nation, HHS is moving with urgency to address SDOH and unmet health-related social needs (HRSNs) that have the potential to worsen health and wellbeing.   

The impact of diet on chronic conditions and other poor health outcomes is well documented. Despite this knowledge, health outcomes resulting from diet-related conditions and disease continue to move in a concerning direction. The toll of diet-related chronic conditions is not distributed equally and is a result of a complex web of factors that also contribute to health disparities.  

Studies have highlighted the many systemic barriers to healthy eating. For example:

• Lack of necessary cookware or knowledge on how to prepare certain foods. 
• Poor-quality food at local stores that individuals do not feel safe consuming. 
• Insufficient time or energy to regularly prepare healthy meals. 
• Fear within communities that have been marginalized (e.g., LGBTQIA+ people, recent immigrants) of potential discrimination or rejection by state agencies and nonprofit organizations involved in food security programs.  
• Rising cost of living and stagnating wages can perpetuate food insecurity and exacerbate other barriers (e.g., transportation difficulties). 
• Potential barriers when redeeming vouchers for fruit and vegetable interventions (e.g., retailers not accepting vouchers) due to a lack of point-of-sale infrastructure.  

These challenges highlight the importance of community- and society-level solutions when addressing nutrition inequities and chronic health conditions and are important to consider in design of FIM interventions.

Participant representation during FIM program design and implementation is an essential component to reflect back community needs and ensure successful program outcomes. FIM program administrators and physicians can also survey participants on challenges encountered when using FIM programs to identify barriers and personalize FIM interventions based on participant needs.

Best practices to collaborate with individuals with lived experience include:

1. Engage with trusted community leaders and organizations 
2. Facilitate open forums with community members, such as listening sessions, focus groups, and individual assessments throughout program design, implementation, and evaluation 
3. Evaluate the landscape of assets and barriers in the community 
4. Establish communication channels that foster ongoing feedback and adaption to support longevity of programs 
5. Compensate community members for their time and expertise

These practices should be applied when designing FIM interventions. It is important to establish a network of trusted community partners, especially those with lived experience and a deep understanding of the population served by the FIM intervention as well as the food landscape in which the program is implemented.   

As the health care system shifts toward identifying and addressing individuals’ social risk factors, creating opportunities for organizations from different sectors to come together with a shared vision and collaborative approach that aligns to lived experience needs will facilitate better care coordination.   

Food is not merely a source of nutrients; it can be tied to personal, cultural, religious, racial, and political identities. Many cultures and populations have linked food with medicine for centuries, and the distinction between food and medicine varies between cultures and time periods.  

Ensuring cultural sensitivity in FIM and food assistance programs remains a major challenge that can limit the effectiveness of these programs. Multiple authors have highlighted approaches for ensuring cultural sensitivity in FIM interventions, including the following:

• Partnering with community-based organizations and participants during the design and implementation of FIM programs   
• Providing greater flexibility in FIM offerings and ways to access resources, including the option for vouchers rather than preset boxes or offerings at food pantries 
• Providing opportunities for communication and collaboration between program participants (e.g., trading recipes, tips, and other support) 
• Partnering with community champions to identify potential barriers and encourage FIM program use 

HHS resources have described qualities and actions that partners in different sectors contribute to help build a stronger, more integrated health and social care system that supports Food Is Medicine interventions. 

Addressing Health-Related Social Needs in Communities Across the Nation

This call to action complements the companion U.S. Playbook to Address Social Determinants of Health, highlighting the critical need to develop well-coordinated health and social care systems to better address HRSNs, and describes actions the federal government is taking to promote this transformation.  

Methods and Emerging Strategies to Engage People with Lived Experience 

This brief identifies methods and emerging strategies to engage people with lived experience in federal research, programming, and policymaking. It draws on lessons learned from federal initiatives across a range of human services areas to identify ways that federal staff can meaningfully and effectively engage people with lived experience. 

Tips on Engaging Diverse Groups of External Partners 

This tip sheet provides key considerations for how organizations can identify potential diverse external partners, conduct outreach to them, and build and sustain productive relationships with them. 

Supporting Food and Nutrition Security through Healthcare 

This resource summarizes the ways in which health care systems, public health practitioners, and public health allies can partner to support food and nutrition security in their communities through programs, policies, and practices. 

It is written through the lens of supporting actors to work together to address diet-related health disparities, including health care systems and payors, state health agencies, local health departments, and other public health allies such as universities, community-based organizations, and Centers for Disease Control and Prevention (CDC) grantees.