Navigating the complexity of food insecurity screening

The US Preventive Services Task Force (USPSTF) works to improve the health of people nationwide by making evidence-based recommendations for preventive services, including screening, behavioral counseling, and preventive medications. The USPSTF recognizes the important connection between a person’s social and economic conditions and their health. In 2020, the task force published a report on methodological considerations for developing primary care recommendations that address social determinants of health (also referred to as “social drivers” of health). Following that publication, a preliminary examination of the evidence suggested the potential for identifying primary care–based interventions for food insecurity. As a result of that preliminary examination, screening for food insecurity was selected as the first social determinant of health (SDOH) topic, which fundamentally differs from most other topics in the USPSTF portfolio. Screening for food insecurity may have a substantive impact on access to, and benefits of, other preventive services. For example, if a patient or their family have insufficient food at home, how could they effectively follow advice for healthy eating and physical activity to prevent obesity? Moreover, building relationships with patients and their families must include an understanding of their challenges of daily living, including the consistent availability of food.

However, as the task force formally reviewed the evidence to make a recommendation on screening for food insecurity, it came across several challenges: (1) food insecurity is a problem that cannot be solved solely within the primary care setting but must be addressed more broadly within a societal and economic context; (2) for the task force to recommend screening, there needs to be evidence that a subsequent primary care intervention for people who screen positive improves health outcomes; and (3) the task force’s established methods for assessing the benefits and harms of a preventive intervention may not be the best approach to address all SDOH topics. These challenges are reflected in the USPSTF’s I statement (published concurrently in JAMA), which states that the evidence is insufficient to make a recommendation for or against screening for food insecurity in primary care.