The Podium

Putting food on the table

Food insecurity is a social justice problem. As many as two billion people worldwide are in a state of food insecurity on an intermittent basis, according to the Food and Agriculture Organization.

In the United States, food insecurity hit record levels in 2010 when the number of households uncertain of where each day’s meals will come from reached 17.2 million. That’s one in seven U.S. families.

The daily struggle to put food on the table also has a direct link to the $3.2 trillion Americans spend on health care every year.


At the heart of the Affordable Care Act is the recognition that we cannot keep pace with the staggering costs of treating chronic diseases and critically ill people with acute care services: emergency room visits, hospital stays, and nursing home admissions.

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Malnutrition is one of the greatest contributors to hospital and nursing home admission and readmission.

If you are a young mother facing breast cancer or a man struggling with kidney dialysis, it is impossible to stay out of the hospital if you lack the physical or emotional strength to shop for groceries, cart them home and prepare a meal.

This is a costly problem for all of us.

It takes about $20 a day to feed someone nutritious meals at home. It costs upwards of $4,000 a day for a hospital stay.


Community Servings was founded in 1990 to serve those with HIV and AIDS. One of the things we’ve learned in providing meal delivery services to HIV patients over the past 23 years is that medically tailored meals strengthen the immune system and enable the body to better fight the disease.

Good nutrition acts as a positive catalyst – helping the body process medications.

In the same way it helps HIV patients recover, heal and lead a higher quality life, a medically tailored diet has similar benefits for people suffering from other illnesses.

Cancer. Heart failure. Diabetes. Liver disease. Kidney failure: there is a direct relationship between diet and nutrition and the effectiveness of treatment and disease management.

Today Community Servings provides more than two-dozen medically tailored diets to 1,300 patients in 18 Massachusetts communities battling cancer, diabetes, heart failure, immune deficiencies and many other conditions.


Most of our patients – were it not for the home-delivered meals – would be unable to feed themselves or their families.

In many households we encounter patients who are routinely confronted with the decision of whether to feed their families or purchase medicine.

On a very basic human rights level – nobody should ever have to make such a decision. And from the perspective of creating the best healthcare outcomes for patients with a variety of conditions, the importance of proper diet is critical.

And this is where the individual experiences of the food insecure become very relevant to health care policy.

Those who are food-insecure are more likely to miss medical appointments, have poor medication adherence, make frequent trips to the emergency room, and have poorer health outcomes. A recent survey of healthcare workers conducted by Community Servings and Daniel J. Cohn, an Emerson National Hunger Fellow at the Congressional Hunger Center, found an overwhelming majority of respondents (96 percent) reported that medically tailored home-delivered meals improved their clients’ health. Nearly two thirds (65 percent) believed the meals program had resulted in decreased hospitalizations for their clients.

Healthcare workers who were interviewed for the study reported that, prior to enrollment in Community Servings’ nutrition program, many of their homebound patients were relying solely on readily available dining options like prepackaged snack food that didn’t come close to meeting the dietary requirements of their illnesses.

The Affordable Care Act that goes into effect in 2014 requires every state to establish an Essential Health Benefits Package. A wise investment and smart policy move by every state would be to include food and nutrition services in those benefits and codify the outcome-based belief that “food is medicine” into our health care system.

As it stands now, the ACA allows each state to decide what services are included in the Essential Benefits Package. That means there is a strong likelihood of a wide variability in coverage from state to state.

There’s a better way.

The US Department of Health and Human Services should consider the inclusion of food and nutrition services — when delivered as part of a doctor’s recommendation and prescribed by a registered dietitian — as an Essential Health Benefit.

To do otherwise undermines the intent of the ACA — which is to provide greater access to health care while lowering medical costs.

Better access to a healthy diet for those who are chronically ill and food insecure accomplishes just that.

David Waters is CEO of Community Servings in Boston.