Are the poor’s health problems made worse by nutrition programs designed to help them?

Government programs designed to reduce food insecurity among poor Americans may be contributing to health problems, and adding to the nation’s spiraling health spending, due to the way the benefits are distributed.

That is the conclusion of a study published in the January issue of Health Affairs examining the relationship between health outcomes and the way government aid to the poor is distributed. The study compares the hospital admission rates for treatment of hypoglycemia among residents of California living in low-income ZIP codes to the rates for people living in more-affluent ZIP codes between 2001 and 2007.

The researchers found that hospital admissions among low-income residents due to hypoglycemia increased from 240 per 100,000 total admissions in the first week of the month to 260 in the second week to 290 in the third week and 300 in the last week of the month. By contrast, weekly hypoglycemia-related admissions among non-low-income Californians were 200, 190, 200, and 200, respectively. The admission rate-ratios for the low-income group were 1.10, 1.23, and 1.37 for the second, third, and fourth weeks, respectively.

The authors, led by Hilary K. Seligman, MD, assistant professor in the department of medicine at the University of California, San Francisco, focused on hypoglycemia based on two premises. First, because benefits such as the Supplemental Nutritional Assistance Program (SNAP) are distributed at the beginning of each month, the people who receive them frequently have exhausted their food budgets by the end of the month, and consequently eat less. Second, among people with diabetes, a stable dose of medication for glycemic control combined with reduced food intake will result in increased risk for hypoglycemia.

The authors note that health consequences of hypoglycemia can include acute symptoms and traumatic accidents, while increasing the risk of dementia among elderly. It is also among the most common adverse drug events leading to hospitalization and emergency department visits, both of which are very costly compared with outpatient care.

Possible solutions to the problem include distributing SNAP and other benefits more frequently than once per month, and establishing protocols at hospitals and other healthcare settings for referring low-income patients with diabetes to food pantries and soup kitchens.  More broadly, the authors suggest that the most effective strategy would be to increase levels of SNAP benefits so that recipients don’t run low on food at the end of the month.