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Food or medicine? Tough choice for many

WASHINGTON — Nearly 1 in 3 adults with a chronic disease has trouble paying for food, or medicine or both, according to a new study published in the American Journal of Medicine.

Using data from the 2011 National Health Interview Study, lead author Seth Berkowitz, a fellow at Harvard Medical School, and colleagues at the University of California, San Francisco examined almost 10,000 adults who indicated they have arthritis, asthma, chronic obstructive pulmonary disease, diabetes, high blood pressure, a mental health problem or stroke. Of those, 23.4 percent said they sometimes can’t afford their medicine, 18.8 said they hadn’t been able to afford food at some point within the previous month, meaning they fit the U.S. Department of Agriculture’s definition of “food insecurity.” 

One in 9, or 11 percent, said they had trouble paying for both medicine and food.

Berkowitz, who is also an internist at Boston General Hospital, said he was surprised at how high the rate is of adults with chronic diseases who struggle to pay for life’s necessities: almost 1 in 3.

“They are pretty strongly correlated,” he said. “It paints the picture of that a lot of folks are really hurting and in dire straits in a lot of parts of the country.”

At 17.9 percent, or 653,000 people, Oregon’s food insecurity rate was above the national average of 16.4 percent in 2011, according to the anti-hunger group Feeding America. 

Curry County’s rate was 16.0 percent, or 3,580 people, while Coos County was 16.5 percent, or 10,440 people.

Crook County’s rate was 17.8 percent, or 3,810 people, while Jefferson County was 18.0 percent, or 3,920 people.

“Adults with chronic diseases are often faced with a lot of choices where there aren’t many good options,” said Leslie Richards, an assistant professor at Oregon State University’s College of Public Health and Human Services. This is particularly true in areas with high food insecurity, which makes finding healthy food a challenge, she said.

“If you’re food insecure, you’re going for the cheapest food you can find,” she said. “The food banks are trying really hard to get healthy food to people, but a lot of (their) food comes through food drives,” where people often donate heavily processed food that’s often high in fat and sugar and has very little nutritional value.

“If you go to a discount grocery store, almost all of the food is highly processed,” she said.

The situation can be made worse in food deserts, which the USDA defines as areas where households don’t have easy access to fresh, healthy and affordable food. Curry, Deschutes, Crook and Jefferson counties all have one census tract that qualifies as a food desert, according to the USDA.

“If you’re poor, you probably don’t own a vehicle. If you live in a rural community, there are no buses,” said Richards. “If you live in an area where you’re doing a lot of your shopping in a mini-mart, there’s really not a lot (of healthy food) there.”

In a ranking of counties by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute based on a number of health outcomes, including length and quality of life, and factors, including health behaviors and physical environment, Curry was the 21st-healthiest county in Oregon. The healthiest county was Benton, and the least healthiest county was Malheur. 

The American Journal of Medicine study also found that individuals with chronic diseases on Medicaid or who participated in the Special Supplemental Nutrition Program for Women, Infants and Children, or WIC, were less likely to not have money for medicine or food.

While acknowledging that his findings are the result of a single study, Berkowitz said they could have important policy implications.

“When we think about health care, our vision in a lot of people’s mind is one doctor, one visit,” he said. But issues like having to choose between paying for food or medicine can’t be solved by individual providers.

One possible solution is better coordination among community health care systems, social services, community programs and philanthropic organizations, he said.

“We need to approach chronic disease management at a more system(-wide) level,” he said. 

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