Today, we continue our blog series, Medical Research on Health and Housing, which analyzes and summarizes current medical literature exploring the multiple links between health and housing. For this post, Haiyan Huang and Jenny Liang have worked with MHSA Advisory Council Member Dan Dworkis, MD-PhD, to analyze research about the connection between people who are experiencing homelessness and their quality of nutrition and health.
CITATION: Koh, K. A., Bharel, M., & Henderson, D. C. (2015). Nutrition for homeless populations: shelters and soup kitchens as opportunities for intervention. Public health nutrition, 7, 1312–1314.
SUMMARY: In this study, the investigators interviewed ten soup kitchen and shelters in the Greater Boston area with the aim of understanding how current practices affect the nutrition of the homeless individuals who are served at each one. The investigators surveyed each kitchen with a standardized questionnaire that asked specifically about current practices, barriers to service and ideas on how to improve the nutrition of homeless individuals.
The main funding source for eight of the ten sites surveyed was from the city and state governments. The most significant barriers to accessing healthy foods were budget constraints and space constraints. A majority of the sites noted that guests responded favorably to healthier food options when available and that the most popular of these options were fruits and vegetables.
The investigators noted several ways in which food quality could be improved at soup kitchens and shelters. One shelter was able to substitute healthier options for staples in their old menu (such as switching white bread for whole grain) while staying within their budget constraints. The shelter was also able to source fruits and vegetables for the kitchen by working with a local food-rescue organization.
The investigators also suggested providing nutrition education for food providers and guests to encourage the creation and consumption of healthy meals. Advocacy suggestions included increased public assistance in the form of funding for specific items such as refrigerator or freezer space, or increasing food standards for foods purchased and served by city agencies.
WHAT THIS MEANS: This study suggests that offering healthier food options in shelters and soup kitchens is tentatively possible but vastly limited by budget constraints.
ADVOCACY: Poor nutrition is a serious public health issue that disproportionately affects people living in poverty. The chronic consumption of an unhealthy diet may exacerbate or create new health problems, which are already difficult to manage among this population and may contribute to increased health expenditures. Those who rely on soup kitchens or shelters for their meals often times do not have any other means of obtaining sustenance, which gives these institutions a critical role in improving the lives of those who are most disadvantaged.
This study determined that lack of budget and lack of space were the two greatest barriers to delivering healthier food options. Partnerships with local food rescues or grocery stores have been demonstrated to be a good source of healthier options, but merely obtaining these perishable fruits and vegetables is not enough if the kitchen does not have a proper place to safely store them. More public funding should be available to provide improved infrastructure to support healthier food options.
Ultimately, the most effective way to improve nutrition for people experiencing homelessness is to place them in housing. With their own private access to refrigerator space, it would no longer be necessary to rely on soup kitchens or food shelters to store healthier, more perishable fruits and vegetables. It would also give them greater autonomy in their food decisions, allowing them to adjust their diet as needed to match any specific health-related needs. While it is crucial to improve the quality of food available for soup kitchens and shelters to serve, the long-term goal of eradicating homelessness and securing stable housing remains the best way of keeping people experiencing homelessness healthy.
About the Authors:
Haiyan (Adele) Huang is a medical student at Boston University School of Medicine. She is actively involved with Massachusetts Medical Society as a student member, and she hopes to use her training to advocate for patients from underserved backgrounds.
Jenny Liang is a medical student at Boston University School of Medicine. She is part of the steering committee at Right Care Boston, a grassroots effort striving to open the conversation about improving health care to the entire Boston community. She is also involved in research seeking to improve LGBTQIA medical education. She hopes to spend her career advocating for patients who come from marginalized backgrounds.
Dan Dworkis, MD-PhD, is a senior resident in emergency medicine in the Department of Emergency Medicine at Harvard Medical School and the founder of The Lever Institute, which builds theory and tools to help develop ERs into fulcrums for positive change in the communities they serve.