Is there a way for our country to lower health care costs, improve medical outcomes and feed some of the most vulnerable individuals in our society? Yes. But it will require each state making sure that they include food and nutrition services as part of their Essential Health Benefits package, a provision of the Affordable Care Act that goes into effect in 2014. States and the federal government can learn a lot about the relationship between food and nutrition and better health from the experience that individuals living with HIV, and the organizations that work with them, have had over the past two decades.
Both God's Love We Deliver in New York and Community Servings in Boston were established during the height of the AIDS crisis in the 1980s and early 1990s as a way of providing treatment to people living with HIV and AIDS. At the time, before any medicines were developed to help the men and women who had acquired the disease, the only real way to treat patients was to feed them. Individuals with the virus were wasting away, and making sure that they had good, nutritious food was one of the few ways to slow the progression of the disease.
With the introduction of antiretroviral medications, people living with HIV have more effective ways to manage the disease, but good nutrition has still proven to be a very important part of treatment for patients. It is considered so necessary a medical therapy that the federal government named food and nutrition services as core medical services in the most recent reauthorization of the Ryan White CARE Act, the legislation that provides federal funding for the treatment of HIV/AIDS. And yet, even today, many people living with HIV/AIDS are also living with food insecurity. In the New York City area, 89 percent of HIV/AIDS patients are experiencing food insecurity, with 80 percent of these individuals relying on the food stamp program. This has an adverse effect on their medical outcomes, as the food-insecure are more likely to miss appointments, make frequent trips to the emergency room and have poorer health outcomes.
The Ryan White CARE Act is one of the few federal health programs that explicitly include funding for nutrition services as part of health care. As the options for treatment expanded for men and women living with HIV/AIDS, our organizations recognized that we could apply the knowledge we learned about proper nutrition and healing to individuals struggling with other serious illnesses, like cancer, diabetes, heart disease and renal failure. Both Community Servings and God's Love We Deliver provide nutritious, medically-tailored, home delivered meals to chronically and critically ill people. Most of our clients are low income. And we've learned that good nutrition can help people with many different diseases have better health outcomes and, thus, can assist in the quest to lower health care costs.
Why is that? Because malnutrition is one of the greatest contributors to admission and readmission to hospitals and to admissions into nursing homes. Hospital stays cost money, as do trips to the emergency room. Chronically and critically ill individuals who can remain in their homes while battling whatever health challenge they face can be part of the solution to reduced medical costs. But 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 can't eat.
And chronically sick individuals tend not to have the energy or inclination to cook for themselves or their families. Just do the math: it costs about $20 a day to feed someone nutritious meals at home and it costs upwards of $4,000 a day for a hospital stay.
The passage of the Affordable Care Act and its implementation gives us a rare opportunity to change the way we see nutrition: food is medicine, and we have the chance to codify that belief into our health care system. We strongly believe that the U.S. Department of Health and Human Services (HHS) should consider the specific inclusion of food and nutrition services, when delivered as part of a doctor's recommendation and prescribed by a registered dietitian, as an allowable service category within the prevention and wellness services and chronic disease management category of the Essential Health Benefits. Currently, the language allows each state to decide what will be in the package, which we think will lead to variability of coverage, undermining the purpose of the ACA -- which is to provide greater access to health care while lowering medical costs.
Barring action by HHS, we will have to work state-by-state to educate policymakers on why funding nutritious services is smart health and good public policy for the long-term. Let's learn the hard-won truths of the AIDS crisis -- food is medicine and many Americans would heal if only they had better access to a good meal.
David Waters is CEO of Community Servings in Boston. Karen Pearl is President and CEO of God's Love We Deliver in New York City.
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