In the United States, food insecurity — or the lack of consistent access to enough food for an active, healthy life — is an important and often hidden problem. In 2015, 15.8 million US households (12.7 percent of the U.S. population) were food insecure at some time during the year.

People experiencing food insecurity have poorer quality diets, are more likely to be overweight or obese, and are at greater risk of diet-related chronic health conditions than the general population. Food insecurity may put people in the position of making trade-offs between healthy food, medicine, and other essential needs and makes it more difficult to manage chronic health conditions.

A study of Feeding America food bank clients found that 66 percent of households choose between paying for food and medicine or medical care each year, while 55 percent choose between paying for food and housing. 

Food banks play a central role in the network of national, regional, and local organizations working together to address the needs of food insecure communities across the nation.

Food banks secure food donations from the food and grocery industries, government agencies, individuals, and other organizations and make this food available to local charitable feeding programs. Operating like warehouse and distribution centers, food banks receive, sort, review for quality, store, and distribute food to smaller agencies that provide food directly to clients.

Where food banks source and channel food resources at large scale, food pantries provide food directly to food insecure individuals and families in their communities. For example, the Greater Pittsburgh Community (GPC) Food Bank distributes food to over 400 agencies in an eleven-county service area in southwestern Pennsylvania. These agencies are nonprofit community or government agencies, including food pantries, soup kitchens, and homeless shelters. This network of agencies allows the GPC food bank to distribute 26.5 million pounds of food to 360,000 people annually.

Over 200 regional food banks nationwide are members of Feeding America, the largest hunger-relief organization in the United States. Feeding America delivered four billion meals to individuals and families facing hunger in 2016 through various initiatives including food rescue efforts, food pantries, backpack programs, and Supplemental Nutrition Assistance Program (SNAP) Outreach.

Because food insecurity and health are interrelated, many health care providers have begun to screen patients for food insecurity and connect food insecure individuals to food resources including food pantries.

Hospitals can also partner with food banks and pantries to conduct chronic disease screening — a valuable contribution to community health since so many individuals relying on emergency food are living with diet-sensitive chronic disease. In fact, 58 percent of households that rely on the emergency food bank network reported in 2014 that at least one household member has hypertension and 33 percent reported that at least one member has diabetes. Food banks and pantries offer hospitals important opportunities for health interventions to prevent and treat diet-related health conditions.

Challenges for food banks in providing healthier foods

While food banks and food pantries are critical food sources to address food insecurity, they are not always sources of fresh, healthy food. Food banks often receive donations of less-healthy options, including canned or packaged food products that have a longer shelf life and are easy to store and distribute.

In order to address both food insecurity and support healthy diets to prevent and treat chronic disease, food pantries need to provide a variety of healthy foods. However, lack of staff and physical infrastructure and chronic funding shortages can make it difficult for a food pantry to secure and distribute healthy items, especially fresh fruits and vegetables. Many food pantries only distribute food to clients a few times per month or don't have the refrigeration capacity necessary to handle fresh produce. Food pantries can move toward becoming sources of fresh, healthy food. Hospitals can play an important role in supporting these efforts.

Establishing nutrition standards can be an effective strategy to improve the nutritional quality of the food distributed. These standards generally focus on increasing healthy food offerings and eliminating certain unhealthy products by developing criteria to determine what products food banks purchase and what types of donations they will and will not accept. A national survey of 137 food banks found that only 39 percent reported having some type of organizational nutrition policy or guidelines and fewer than a third reported having guidelines to decrease foods or beverages with limited nutritional value (e.g. sugar-sweetened beverages and packaged snacks).

Food banks and pantries may be cautious when implementing strong nutrition standards out of concern that it may reduce the total amount of food available for distribution. Yet this worry may be misplaced. The Capital Area Food Bank (CAFB) received overwhelming support from retail donors when it established its nutrition policies. For example, Giant Food, a key donor, implemented a “Retailers for Wellness” program that sorts out soda, bakery items, and candy from food bank donation bins and prepares nutritious boxes for customers to purchase for donation at checkout.

Recommendations for hospital participation

There are many examples of successful partnerships between hospitals and food banks or food pantries to increase access to healthy foods. These include partnerships that help to expand the reach and improve the quality of foods provided by local food banks and food pantries, providing funding for targeted projects, and helping food banks develop nutrition policies.

• Healthy food can be sourced from farm gleaning, farmers market gleaning, plant-a-row programs in the local community, as well as from retail sources. Hospital staff can act as liaisons for these initiatives.

• Hospital grounds can be utilized as gardens to produce donated foods.

• Hospitals can offer grant support to purchase refrigerators, which are required to sustain the offering of healthy, but perishable goods.

• Hospital food purchasers may also be able to support food bank staff with identifying vendors for healthy food products or with negotiating pricing.

Additionally, food bank-health care partnerships often include an educational component in which participants learn about nutrition and healthy eating, healthy meal preparation, and also are given a selection of fresh, healthy foods for cooking at home.

Hospital staff members are in a unique position to identify both food insecurity and health risks in patients that would qualify for additional food assistance. Hospitals can assist in the identification and referral of patients and other community members to external food banks, offer in-house emergency food assistance, and offer grant support for mobile food banks and pantries to operate in target communities.

Additional information about hospital community benefit roles and examples are included in the table below.

Examples of hospital roles and participation

Feeding America’s discussion of food bank-health care partnerships provides resources and recommendations for health care organizations and hospitals that are forging partnerships with food banks.

Feeding America’s healthy pantry initiative toolkit provides guidance and strategies for increasing healthy food options at food pantries.

Harvard Law School and Feeding America partnered to release a report on food banks as partners in health promotion including sections on collaboration with hospital community benefit departments and healthy food procurement.

Community Food Centres, located in Canada, offers a toolkit for food banks, hospitals, and relevant stakeholders to transform their emergency food assistance programs into preventative medicine initiatives by incorporating and encouraging healthy foods.

The Public Health Institute published a comprehensive resource for improving healthy food and beverage standards in food banks.

Change Lab Solutions’ Banking on Health resource offers guidance for improving nutrition and beverage standards in food banks.

Northwest Harvest’s Resource Guide for Farm-to-Food Bank Strategies offers guidance for increasing the amount of local, fresh foods in food banks.

Northwest Harvest also published a Promoting Healthy Food Guidebook for improving healthy food signage and selection and nutrition education in food banks.

County Health Rankings & Roadmaps offers guidance, resources, and provides examples for improving healthy food initiatives in food banks.