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ARTICLE

Is addressing food insecurity the key to preventing and managing chronic disease?

Published: August 7, 2023

Three in 5 Americans live with a chronic disease — and 2 in 5 have 2 or more.1 A staggering 90% of the nation’s $4.¹ trillion annual health care expenditures go toward treating patients with chronic diseases.²So it’s no surprise that chronic disease prevention and management have been top of mind for employers for decades. However, many employers still don’t realize the deep connection between nutrition and chronic disease. Diet plays a pivotal role in the prevention, management, and treatment of serious and costly chronic illnesses — including type 2 diabetes, obesity, and heart disease. In fact, 1 in 5 deaths can be attributed to poor diet.³And while most employees are aware that healthy eating can reduce their risk, many are also dealing with food and nutrition insecurity — which costs the U.S. health care system an additional $53 billion per year by triggering or worsening chronic diseases and driving up emergency room visits, hospitalizations, and readmissions.⁴

Conventional wisdom suggests that bringing home a steady paycheck should protect employees from any health threats related to food and nutrition insecurity — but it’s more pervasive than some people think. The reality is that 1 in 4 Americans live with food insecurity, and half of them are employed.⁵ So what can employers do to reverse this trend, better prevent and manage diet-related chronic diseases, and ultimately improve workforce heath?

Half of all Americans experiencing food insecurity are employed

“When people are hungry, or lack proper nutrition and equitable access to healthy food, they’re less likely to get or stay healthy. It’s time to reimagine what the food and nutrition landscape can and should look like as part of a healthier, more equitable society.”

— Bechara Choucair, MD, senior vice president and chief health officer at Kaiser Permanente

The cost of chronic disease in the workplace

Diet-related chronic diseases are causing health care costs to skyrocket. Each year, conditions like type 2 diabetes, obesity, and heart disease cost employers billions of health care dollars, on top of indirect expenses like absenteeism, presenteeism, and disability. In fact, chronic diseases cost U.S. employers $36.4 billion per year in absenteeism alone.⁷

Diabetes — Health care costs for employees with diabetes are increasing by almost 20% year over year.⁸ Employers pay an additional $10,968 per employee, per year.⁹
Obesity — Additional health care costs for employees with obesity range from $2,299 to $14,316 per employee, per year.¹⁰
Heart disease — Heart disease accounts for $1 in every $7 spent on health care in the U.S.¹¹ And diet-related risk factors for heart disease — also associated with food insecurity — increase health care costs even further:
- High blood pressure adds $7,418 per employee, per year¹²
- High cholesterol adds $6,765 per employee, per year¹³

“It’s important to understand the connection between good nutrition and food security. Consistent access, availability, and affordability of healthy food is essential to overall health and can help prevent the diet-related diseases that are currently driving up the cost of health care.”

— Pamela Schwartz, MPH, executive director of community health at Kaiser Permanente

Employees experiencing food insecurity are 2 times more likely to have poor physical and mental health, multiple emergency room visits, and inpatient hospital stays

One in five deaths are related to poor diet

A deeper dive into food and nutrition insecurity’s impact

While employers foot the bill for the majority of added health care expenses, employees are feeling the financial burden, too. Food-insecure families pay about 20% more in annual out-of-pocket health care costs — an average of $2,500 — than their food-secure counterparts.¹⁶ Employees experiencing food insecurity are more likely to delay or go without medical care.¹⁷ And they’re more than twice as likely to have poor physical and mental health, multiple emergency room visits, and inpatient hospital stays.¹⁸ This can be especially dangerous for employees with chronic diseases, who require regular care and support to monitor and manage their conditions and prevent them from becoming more serious, debilitating, and costly over time.

Employers’ role in reversing this worrisome trend

Food insecurity and chronic disease are highly complex issues — there’s no easy fix or one-size-fits-all solution. By simply speaking openly about it, employers can help destigmatize food insecurity and create a psychologically safe space for employees who might be struggling. Businesses that prioritize and invest in addressing workforce food and nutrition insecurity can help improve individual, organizational, and community outcomes.

“It’s going to take a village to change the current trajectory of diet-related chronic diseases and food insecurity. Employers can absolutely play a critical role in making that happen.”

— Pamela Schwartz, MPH, executive director of community health at Kaiser Permanente

Increase awareness and promote nutritional literacy. Educate your team about nutrition and its relationship to chronic diseases. Most Americans think their diet is healthier than it is, so improving awareness is a great first step.¹⁹ Simple interventions — like helping employees understand how to read food labels and estimate healthy portion sizes — can empower them to adopt healthier eating habits for life.

Share local and community food resources. Consider partnering with local food banks, or even just shining a light on available community resources and how employees might qualify. You can also promote awareness about school nutrition programs providing healthy meals to kids throughout the year. Food stamps can provide important assistance, but 1 in 6 eligible people don’t apply for them.²⁰

One in six people eligible for food stamps don't apply for them

Stigma and lack of awareness could be to blame for eligible people not using food stamps

Speak to diverse cultures and backgrounds. Employers need to address food insecurity in a way that reflects who their employees are. There’s not one single way to eat healthy — employees benefit from information that’s relevant to their individual cultures and preferences, and centers around foods that are readily available and affordable in their neighborhoods.

Help employees access healthy food at work. Make choosing healthy foods easy by identifying smart options in vending machines, evaluating what’s served in the cafeteria, if you have one, and consider holding on-site farmers markets or healthy food trucks.

Food as medicine: Prioritizing nutrition in health care

Around 400 B.C., Hippocrates said, “Let food be thy medicine and medicine be thy food.” This idea is now at the center of a nationwide conversation focused on the intersection of nutrition, food security, chronic disease, and health care. In 2022, the White House announced $8 billion in public and private sector commitments to support this initiative — a powerful first step towards helping communities eliminate food and nutrition insecurity, achieve health equity, improve health outcomes, and reduce health care costs.

“In 2018, we crowdsourced ideas on how Kaiser Permanente could better help our members and communities get their basic human needs met. Out of more than 2,000 ideas, combatting food insecurity rose to the top.”

— Bechara Choucair, MD, senior vice president and chief health officer at Kaiser Permanente

Kaiser Permanente is proud to be part of this critical initiative
Some ways we’re making an impact include:

Screening members for food and nutrition insecurity as part of routine primary care
Working to expand access to healthy purchasing options in our communities
Implementing programs like prescriptions for produce and medically tailored meals for members with diet-related diseases

A workforce health issue too big to ignore

Food insecurity and chronic diseases are inextricably linked. Both problems are prevalent, but they’re also often preventable with the right support. Solving such a complex social issue will require close political, organizational, and community partnerships, and employers have an opportunity to make a meaningful difference. The more effort you put into raising awareness and empowering employees to become food secure, the healthier they’ll become — and your business can only benefit as a result.

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About our expert

Bechara Choucair, MD

Bechara Choucair, MD, is senior vice president and chief health officer for Kaiser Permanente. His work includes the creation of the nation’s largest social health network to meet the housing, food, and transportation needs of Kaiser Permanente’s members. He also manages the organization’s community health portfolio, including $3.4 billion dedicated to supporting medical financial assistance and charitable care as well as grants and community health initiatives. From January through November 2021, Dr. Choucair served as the White House national COVID-19 vaccinations coordinator, returning to Kaiser Permanente in December 2021. He holds an MD from the American University of Beirut and a master’s degree in health care management from the University of Texas at Dallas. He completed his family practice residency at Baylor College of Medicine in Houston, Texas.

About our expert

Pamela Schwartz, MPH

Pamela Schwartz, MPH, is executive director of community health for Kaiser Permanente. She leads the organization’s national food security strategy and other social health priorities, including ensuring that social health interventions are integrated seamlessly into care and services provided to Medicaid members. Under her leadership, Kaiser Permanente has designed, tested, and scaled numerous outreach campaigns to enroll members in public benefit programs. Pam oversees Kaiser Permanente’s $50 million Food is Medicine commitment, made alongside the White House Conference on Hunger, Nutrition, and Health. An early advocate in the Food is Medicine movement, Pam has helped establish the evidence base and business case for addressing food and nutrition insecurity at Kaiser Permanente and in health care systems across America.

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Footnotes:

¹“Chronic Diseases in America,” National Center for Chronic Disease Prevention and Health Promotion, cdc.gov, accessed June 25, 2023.
²Travis Rush, “With Health Care Costs Rising Fast, It’s Time to Rein in Chronic Disease Expenses,” ALM Benefits Pro, December 27, 2022.
³“Food as Medicine: Nutrition Interventions for a Healthier Workforce,” Business Group on Health, March 27, 2023.
⁴“A Vicious Circle: Food Insecurity Both a Cause and Effect of Higher Health Care Costs,” Purchaser’s Business Group on Health, February 23, 2023.
⁵Kassandra Martinchek et al., As Inflation Squeezed Family Budgets, Food Insecurity Increased Between 2021 and 2022, Urban Institute, March 21, 2023; Jan Berger et al., “Food as Medicine: Impact of Diabetes Management,” American Journal of Managed Care, July 2, 2020.
⁶Jan Berger et al., “Food as Medicine: Impact of Diabetes Management,” American Journal of Managed Care, July 2, 2020.
⁷See note 2.
⁸Paige Minemyer, “Here’s How Much Diabetes Costs Employers Each Year,” Fierce Healthcare, March 14, 2023.
⁹Jared Ortaliza et al., “How Do Health Care Expenditures Vary Across the Population?” Health System Tracker, November 12, 2022.
¹⁰Abhilasha Ramasamy et al., “Direct, Absenteeism, and Disability Cost Burden of Obesity Among Privately Insured Employees,” Journal of Occupational and Environmental Medicine, February 2020.
¹¹“Control High Blood Pressure, CDC.gov, accessed May 31, 2023.
¹²See note 9.
¹³See note 9.
¹⁴Tamara Baer, “How Healthcare Payers Can Expand Nutrition Support for the Food Insecure,” McKinsey & Company, November 24, 2021.
¹⁵See note 3.
¹⁶See note 4.
¹⁷Jaclyn Bertoldo et al., “Food Insecurity and Delayed or Forgone Medical Care During the COVID-19 Pandemic,” American Journal of Managed Care, January 7, 2022.
¹⁸See note 14.
¹⁹See note 3.
²⁰Thomas B. Foster et al., “Demographic SNAPshot: Not Everyone Eligible for Food Assistance Program Receives Benefits,” United States Census Bureau, February 2, 2021.
²¹See note 20.