Scope of Interventions to Address Food Insecurity

  • Janine S. Bruce
  • Deepak Palakshappa
  • Hans B. KerstenEmail author
Part of the SpringerBriefs in Public Health book series (BRIEFSPUBLIC)


This chapter examines the different types of responses that can occur when a patient or family is identified as having food insecurity (FI). The chapter begins with how an individual healthcare provider responds to a positive FI screen within a clinical setting. Next, there is a discussion of how the larger community or practice can address FI in a broader way largely outside the clinic walls. Finally, the chapter discusses how healthcare providers can affect change by developing and advocating for policy changes in their region or nationally.


Food insecurity Social determinants of health Social needs interventions 



American Academy of Pediatrics


Accreditation Council for Graduate Medical Education


American Medical Association


Community health worker


Electronic health record


Food Insecurity


Federal poverty level


Social Determinants of Health


Summer Food Service Program


Supplemental Nutrition Assistance Program


Temporary Assistance for Needy Families


Well-child check


Special Supplemental Nutrition Program for Women, Infants, and Children


  1. 1.
    Garg A, Dworkin PH. Surveillance and screening for social determinants of health: the medical home and beyond. JAMA Pediatr. 2016;170(3):189–90.CrossRefGoogle Scholar
  2. 2.
    Chung EK, Siegel BS, Garg A, Conroy K, Gross RS, Long DA, et al. Screening for social determinants of health among children and families living in poverty: a guide for clinicians. Curr Probl Pediatr Adolesc Health Care. 2016;46(5):135–53.CrossRefGoogle Scholar
  3. 3.
    Haggerty RJ. Abraham Jacobi, MD, respectable rebel. Pediatrics. 1997;99(3):462–6.CrossRefGoogle Scholar
  4. 4.
    Perrin EC. Ethical questions about screening. J Dev Behav Pediatr: JDBP. 1998;19(5):350–2.CrossRefGoogle Scholar
  5. 5.
    Garg A, Butz AM, Dworkin PH, Lewis RA, Serwint JR. Screening for basic social needs at a medical home for low-income children. Clin Pediatr. 2009;48(1):32–6.CrossRefGoogle Scholar
  6. 6.
    Gottlieb LM, Hessler D, Long D, Laves E, Burns AR, Amaya A, et al. Effects of social needs screening and in-person service navigation on child health: a randomized clinical trial. JAMA Pediatr. 2016;170(11):e162521.CrossRefGoogle Scholar
  7. 7.
    Kumar S, Preetha G. Health promotion: an effective tool for global health. Indian J Community Med. 2012;37(1):5–12.CrossRefGoogle Scholar
  8. 8.
    Gold R, Cottrell E, Bunce A, Middendorf M, Hollombe C, Cowburn S, et al. Developing electronic health record (EHR) strategies related to health center Patients’ social determinants of health. J Am Board Fam Med. 2017;30(4):428–47.CrossRefGoogle Scholar
  9. 9.
    Ashbrook AH-GH, Dolins, J., Davis, J., Watson, C. Addressing food insecurity: a toolkit for pediatricians. Food Research and Action Center, American Academy of Pediatrics; 2017 Feb 2017.Google Scholar
  10. 10.
    Gottlieb LM, Tirozzi KJ, Manchanda R, Burns AR, Sandel MT. Moving electronic medical records upstream: incorporating social determinants of health. Am J Prev Med. 2015;48(2):215–8.CrossRefGoogle Scholar
  11. 11.
    Thornton RL, Glover CM, Cene CW, Glik DC, Henderson JA, Williams DR. Evaluating strategies for reducing health disparities by addressing the social determinants of health. Health Aff (Millwood). 2016;35(8):1416–23.CrossRefGoogle Scholar
  12. 12.
    Goddu AP, Roberson TS, Raffel KE, Chin MH, Peek ME. Food Rx: a community-university partnership to prescribe healthy eating on the south side of Chicago. J Prev Interv Community. 2015;43(2):148–62.CrossRefGoogle Scholar
  13. 13.
    Bryce R, Guajardo C, Ilarraza D, Milgrom N, Pike D, Savoie K, et al. Participation in a farmers' market fruit and vegetable prescription program at a federally qualified health center improves hemoglobin A1C in low income uncontrolled diabetics. Prev Med Rep. 2017;7:176–9.CrossRefGoogle Scholar
  14. 14.
    Savoie-Roskos M, Durward C, Jeweks M, LeBlanc H. Reducing food insecurity and improving fruit and vegetable intake among Farmers' market incentive program participants. J Nutr Educ Behav. 2016;48(1):70–6. e1.CrossRefGoogle Scholar
  15. 15.
    Cohen AJ, Richardson CR, Heisler M, Sen A, Murphy EC, Hesterman OB, et al. Increasing use of a healthy food incentive: a waiting room intervention among low-income patients. Am J Prev Med. 2017;52(2):154–62.CrossRefGoogle Scholar
  16. 16.
    Bowling AB, Moretti M, Ringelheim K, Tran A, Davison K. Healthy foods, healthy families: combining incentives and exposure interventions at urban farmers' markets to improve nutrition among recipients of US federal food assistance. Health Promot Perspect. 2016;6(1):10–6.CrossRefGoogle Scholar
  17. 17.
    Buyuktuncer Z, Kearney M, Ryan CL, Thurston M, Ellahi B. Fruit and vegetables on prescription: a brief intervention in primary care. J Hum Nutr Diet. 2014;27(Suppl 2):186–93.CrossRefGoogle Scholar
  18. 18.
    Carlson S, Rosenbaum, D., Keith-Jennings, B., Nchako, C.Center for Budget and Policy Priorities. Published September 29th, 2016.
  19. 19.
  20. 20.
    Greater Philadelphia Coalition Against Hunger website. Accessed December 2017.
  21. 21.
    Philabundance website. Accessed December 2017.
  22. 22.
    SHARE Food Program website. Accessed December 2017.
  23. 23.
    The Children’s Advocacy Project. Accessed December 2017.
  24. 24.
    Kaushal N, Waldfogel J, Wight V. Food insecurity and SNAP participation in Mexican immigrant families: the impact of the outreach initiative. B E J Econom Anal Policy. 2014;14(1):203–40.PubMedGoogle Scholar
  25. 25.
    Levedahl JW. How much can informational outreach programs increase food stamp program participation? Am J Agric Econ. 1995;77:343–52.CrossRefGoogle Scholar
  26. 26.
    Schanzenbach DW. Experimental estimates of the barriers to food stamp enrollment 2009 November 13, 2017 [cited 2017 November 11]. Available from:
  27. 27.
    Bartlett S, Burstein N, Hamiliton W, Kling R, Andrews M. Food Stamp Program Access Study: Final Report. Food Assistance & Nutrition Research Program electronic publication. published November 2004.
  28. 28.
    Crosnoe R, Fuligni AJ. Children from immigrant families: introduction to the special section. Child Dev. 2012;83(5):1471–6.CrossRefGoogle Scholar
  29. 29.
    Jones MK, Bloch G, Pinto AD. A novel income security intervention to address poverty in a primary care setting: a retrospective chart review. BMJ Open. 2017;7(8):e014270.CrossRefGoogle Scholar
  30. 30.
    Cosgrove S, Moore-Monroy M, Jenkins C, Castillo SR, Williams C, Parris E, et al. Community health workers as an integral strategy in the REACH U.S. program to eliminate health inequities. Health Promot Pract. 2014;15(6):795–802.CrossRefGoogle Scholar
  31. 31.
    Murphy JS, Lawton EM, Sandel M. Legal care as part of health care: the benefits of medical-legal partnership. Pediatr Clin N Am. 2015;62(5):1263–71.CrossRefGoogle Scholar
  32. 32.
    Palfrey JS, Hametz P, Grason H, McCaskill QE, Scott G, Chi GW. Educating the next generation of pediatricians in urban health care: the Anne E. Dyson community pediatrics training initiative. Acad Med: J Assoc Am Med Coll. 2004;79(12):1184–91.CrossRefGoogle Scholar
  33. 33.
    Jones L, Wells K. Strategies for academic and clinician engagement in community-participatory partnered research. JAMA. 2007;297(4):407–10.CrossRefGoogle Scholar
  34. 34.
    Wallerstein N, Duran B. Community-based participatory research contributions to intervention research: the intersection of science and practice to improve health equity. Am J Public Health. 2010;100(Suppl 1):S40–6.CrossRefGoogle Scholar
  35. 35.
    Shalowitz MU, Isacco A, Barquin N, Clark-Kauffman E, Delger P, Nelson D, et al. Community-based participatory research: a review of the literature with strategies for community engagement. J Dev Behav Pediatr: JDBP. 2009;30(4):350–61.CrossRefGoogle Scholar
  36. 36.
    Kania J, Kramer, M. Collective impact. Stanford Social Innovation Review [Internet]. 2011. Available from:
  37. 37.
    Edmondson J, Hecht, B. Defining quality collective impact 2014. Available from:
  38. 38.
    Earnest MA, Wong SL, Federico SG. Perspective: physician advocacy: what is it and how do we do it? Acad Med: J Assoc Am Med Coll. 2010;85(1):63–7.CrossRefGoogle Scholar
  39. 39.
    Medical professionalism in in the new millennium: a physician charter. Ann Intern Med. 2002;136(3):243–6.Google Scholar
  40. 40.
    Education 2017. Available from:
  41. 41.
    Council On Community P, Committee On N. Promoting food security for all children. Pediatrics. 2015;136(5):e1431–8.CrossRefGoogle Scholar
  42. 42.
    Law M, Leung P, Veinot P, Miller D, Mylopoulos M. A qualitative study of the experiences and factors that led physicians to be lifelong health advocates. Acad Med: J Assoc Am Med Coll. 2016;91(10):1392–7.CrossRefGoogle Scholar
  43. 43.
    Interactive HTHP. Doctors, dentists, and nurses most trusted professionals to give advice 2009 [661]. Available from:
  44. 44.
    Advocacy & Policy: American Academy of Pediatrics; 2017. Available from:
  45. 45.
    Campbell EG, Regan S, Gruen RL, Ferris TG, Rao SR, Cleary PD, et al. Professionalism in medicine: results of a national survey of physicians. Ann Intern Med. 2007;147(11):795–802.CrossRefGoogle Scholar
  46. 46.
    Gruen RL, Campbell EG, Blumenthal D. Public roles of US physicians: community participation, political involvement, and collective advocacy. JAMA. 2006;296(20):2467–75.CrossRefGoogle Scholar
  47. 47.
    Minkovitz CS, Grason H, Solomon BS, Kuo AA, O'Connor KG. Pediatricians' involvement in community child health from 2004 to 2010. Pediatrics. 2013;132(6):997–1005.CrossRefGoogle Scholar
  48. 48.
    Real FJ, Beck AF, Spaulding JR, Sucharew H, Klein MD. Impact of a neighborhood-based curriculum on the helpfulness of pediatric Residents' anticipatory guidance to impoverished families. Matern Child Health J. 2016;20(11):2261–7.CrossRefGoogle Scholar
  49. 49.
    Klein MD, Alcamo AM, Beck AF, O'Toole JK, McLinden D, Henize A, et al. Can a video curriculum on the social determinants of health affect residents' practice and families’ perceptions of care? Acad Pediatr. 2014;14(2):159–66.CrossRefGoogle Scholar
  50. 50.
    Klein MD, Kahn RS, Baker RC, Fink EE, Parrish DS, White DC. Training in social determinants of health in primary care: does it change resident behavior? Acad Pediatr. 2011;11(5):387–93.CrossRefGoogle Scholar

Copyright information

© The Author(s) 2018

Authors and Affiliations

  • Janine S. Bruce
    • 1
  • Deepak Palakshappa
    • 2
  • Hans B. Kersten
    • 3
    Email author
  1. 1.Stanford University School of MedicineStanfordUSA
  2. 2.Wake Forest School of MedicineWinston-SalemUSA
  3. 3.St. Christopher’s Hospital for Children, Drexel University College of MedicinePhiladelphiaUSA

Personalised recommendations