By Jess Knight.
“Have you ever smoked? And what about alcohol? Anybody else at home with you? What do you do for work?”
A ‘social history’ is an essential component of any medical interview, helping clinicians to understand their patients’ situation, background and the presence of any well-established social risks to health and wellbeing. Used well, it can also be an opportunity to establish a trusting relationship and shared priorities for care based on a mutual understanding of a person’s wishes and life experiences.
But is there something missing? Food bank donation points are a common sight at the entrance to many UK hospitals. However, once inside, clinicians are rarely aware of which of their patients may be in need of – or already in receipt of – such support, and there is limited acknowledgement within health policy of the extent to which healthy food and dietary autonomy are luxuries inaccessible to many.
The number and visibility of food banks in the UK has risen rapidly throughout the past decade, and further increases in need have been reported as a result of the pandemic. The Trussell Trust, the UK’s largest network of food banks, reported an almost 50% increase in parcels distributed between April and September 2020 versus 2019, and similar figures have been observed at independent food banks. With the recent end of the eviction ban, and proposed cessation of the furlough scheme and £20 Universal Credit uplift in September, it is likely that the numbers of people forced to rely on food banks will continue to rise.
So how is this relevant for doctors? Poor diet is the leading risk factor for death and disease worldwide, responsible for 11 million deaths globally in 2017. Food poverty has been specifically linked to worse diabetes control, reduced maintenance of therapeutic antiretroviral drug levels, and chronic stress. An empty fridge is a significant predictor of early readmission to hospital in older adults. However despite this, dietary risks and access to food are not regularly recorded in healthcare settings.
In our article, we suggest that asking more routinely about access to a good diet has the potential to bring multiple benefits for patients and clinicians, including assisting in acute diagnosis and treatment, facilitating signposting to long-term sources of support, promoting dietary autonomy, and reducing the stigma surrounding food poverty and poor dietary ‘choices’. Increasing awareness of food security in clinical practice may also permit the gathering of data required to design effective upstream policy interventions.
The events of the past year and a half have demonstrated powerfully how much work remains to be done in ensuring that healthcare is not only free at the point of use, but that the raw materials of health – be it food, housing, or social support – are genuinely accessible to all. Talking openly and sensitively about these issues may contribute to a cultural shift within healthcare, re-framing inequality and injustice as preventable risks, rather than inevitable inequities. As individual clinicians, we might not feel able to solve the systemic issues which damage people’s health and wellbeing on our own – but asking about them in the first place is a good way to start.
Paper title: Doctors have an ethical obligation to ask about food insecurity. What’s stopping us?
Author: JK Knight and Z Fritz
Affiliations: University of Cambridge School of Clinical Medicine (JK); THIS Institute, University of Cambridge (ZF)
Competing interests: JK is a medical student and one of the directors at Oxford Mutual Aid, a community support group which distributes food parcels and meals to people experiencing food insecurity