Food insecurity tied to higher risk of long COVID – CIDRAP

Report on the Intersection of Food Insecurity and Post-COVID-19 Condition in the United States

Introduction: Aligning Health Outcomes with Sustainable Development Goals

A recent study published in JAMA Network Open establishes a significant link between food insecurity and the prevalence of post-COVID-19 condition, or long COVID, among adults in the United States. The findings underscore the critical interplay between social determinants of health and public health outcomes, directly impacting the achievement of several Sustainable Development Goals (SDGs), notably SDG 2 (Zero Hunger) and SDG 3 (Good Health and Well-being).

Key Findings and Implications for SDG 2 (Zero Hunger)

The research, based on a comprehensive national survey, highlights the persistent challenge of food insecurity, a primary target of SDG 2. The study provides a stark reminder that access to sufficient and nutritious food is a fundamental component of a resilient society capable of withstanding public health crises.

• Data Source: The analysis utilized data from the 2022-2023 National Health Interview Survey (NHIS), covering 21,631 US adults.
• Prevalence of Food Insecurity: 1,807 participants (8%) reported food insecurity, defined as not having access to sufficient food for basic needs. This aligns with broader national data indicating that 13.5% of US households were food insecure in 2023.
• Measurement: Food insecurity was assessed using the 10-item National Center for Health Statistics scale, which measures experiences such as worrying about food running out and skipping meals due to financial constraints.

The Link to SDG 3 (Good Health and Well-being)

The study’s central finding demonstrates how failing to achieve SDG 2 directly undermines progress toward SDG 3, which aims to ensure healthy lives and promote well-being for all. Food insecurity emerges as a significant risk factor for poor long-term health outcomes following a COVID-19 infection.

1. Elevated Risk: Individuals reporting food insecurity had a 73% higher likelihood of experiencing long COVID (Adjusted Odds Ratio [aOR], 1.73; 95% Confidence Interval [CI], 1.39 to 2.15).
2. Definition of Long COVID: The condition was defined as self-reported symptoms persisting for more than three months after an initial COVID-19 diagnosis.
3. Compounding Factors: Other factors associated with an increased risk of long COVID included unemployment, female sex, and a history of smoking, highlighting the complex web of social and health-related vulnerabilities.

Socioeconomic Dimensions: Addressing SDG 1 (No Poverty) and SDG 10 (Reduced Inequalities)

The research reveals crucial insights into the role of social safety nets, such as the Supplemental Nutrition Assistance Program (SNAP), in mitigating health disparities. These findings are directly relevant to SDG 1 (No Poverty) and SDG 10 (Reduced Inequalities), as they illustrate how targeted support systems can protect vulnerable populations from the cascading negative effects of poverty and health crises.

• The Protective Role of SNAP: The strong association between food insecurity and long COVID was primarily observed among individuals not receiving SNAP benefits. This suggests that access to nutritional support may serve as a protective buffer against adverse post-illness outcomes.
• Vulnerability and Employment: A majority of adults receiving SNAP (60%) were not employed, underscoring the link between economic hardship, food insecurity, and health vulnerability.

Policy Recommendations for Sustainable Development

The study concludes with a powerful policy recommendation that aligns with a holistic approach to achieving the SDGs. By strengthening food assistance programs, governments can simultaneously address poverty, hunger, and public health, creating a more equitable and resilient society.

The authors advocate for increased investment in SNAP, framing it as a cost-effective strategy to advance multiple SDGs. Such investment would not only work towards achieving SDG 2 (Zero Hunger) but would also contribute significantly to SDG 3 (Good Health and Well-being) by reducing the estimated $2.6 trillion long-term economic burden of long COVID and improving overall population health.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 1: No Poverty

  The article connects to SDG 1 by discussing social protection systems like the Supplemental Nutrition Assistance Program (SNAP) and highlighting unemployment as a key factor. These are central to poverty alleviation efforts.

• SDG 2: Zero Hunger

  This is the most central SDG in the article. The entire study is based on the concept of “food insecurity,” which is defined as “not having access to sufficient food to meet people’s basic needs.” The article quantifies the prevalence of food insecurity in the US, directly addressing the core mission of this goal.

• SDG 3: Good Health and Well-being

  The article establishes a direct link between a social determinant (food insecurity) and a specific health outcome (post–COVID-19 condition, or long COVID). It explores how food insecurity leads to a “73% higher chance of reporting” long COVID, and mentions that it is also linked to “delayed or forgone medical care” and “worsened mental health,” all of which fall under the purview of SDG 3.

• SDG 10: Reduced Inequalities

  The article highlights a significant health disparity. The fact that a specific group (the food insecure) faces a substantially higher risk of a negative health outcome compared to the general population is a clear example of inequality. The analysis of how SNAP benefits mediate this risk further relates to policies aimed at reducing such inequalities.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 1.3: Implement nationally appropriate social protection systems and measures for all.

   The article directly discusses the Supplemental Nutrition Assistance Program (SNAP), a major social protection system in the US. It analyzes enrollment numbers (“monthly average of 42.1 million SNAP participants in 2023”) and its effectiveness, noting that the association between food insecurity and long COVID was not significant for individuals receiving SNAP benefits. The authors’ call to “investing in SNAP” is a direct recommendation related to this target.

2. Target 2.1: By 2030, end hunger and ensure access by all people… to safe, nutritious and sufficient food all year round.

   The article’s focus on “food insecurity” directly aligns with this target. It uses a formal scale to measure this condition, covering aspects like “worrying about food running out, not being able to afford balanced meals, and skipping meals owing to a lack of money,” which are all dimensions of lacking access to sufficient food.

3. Target 3.8: Achieve universal health coverage, including… access to quality essential health-care services.

   The article mentions that previous literature “links food insecurity with delayed or forgone medical care.” This directly relates to the challenge of ensuring access to healthcare services for all, a key component of universal health coverage.

4. Target 10.4: Adopt policies, especially fiscal, wage and social protection policies, and progressively achieve greater equality.

   The article’s conclusion that “investing in SNAP represents a cost-effective strategy to reduce its burden and improve population health” is a direct call for strengthening a social protection policy to mitigate a health inequality. This aligns perfectly with the goal of using policy to achieve greater equality in outcomes.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• Prevalence of food insecurity

  The article explicitly uses the “10-item National Center for Health Statistics food insecurity scale” to measure this. It provides a concrete data point: “approximately 13.5% of US households were food insecure in 2023.” This serves as a direct indicator for Target 2.1.

• Coverage of social protection programs

  The article provides data on the number of SNAP participants (“monthly average of 42.1 million SNAP participants in 2023”) and the proportion of the food-insecure population covered (“Of those with food insecurity, 32% participated in SNAP”). This is a direct indicator for Target 1.3.

• Disparity in health outcomes based on economic status

  The core finding, a “73% higher chance of reporting post–COVID-19 condition” for those with food insecurity (Adjusted Odds Ratio of 1.73), is a powerful indicator of health inequality. This measures the gap in health outcomes between different economic groups, relevant to Target 10.4.

• Prevalence of specific health conditions

  The article measures the prevalence of “current long COVID.” Tracking this prevalence, especially among vulnerable populations, serves as an indicator for overall population health under SDG 3.

4. Summary Table of SDGs, Targets, and Indicators

Source: cidrap.umn.edu