Article Text
Abstract
Inadequate diet is the leading risk factor for morbidity and mortality worldwide. However, approaches to identifying inadequate diets in clinical practice remain inconsistent, and dietary interventions (on both individual and public health policy levels) frequently focus on facilitating ‘healthy choices’, with limited emphasis on structural constraints. We examine the ethical implications of introducing a routine question in the medical history about ability to access food. Not collecting data on food security means that clinicians are unable to identify people who may benefit from support on an individual level, unable to consider relevant dietary risk factors for disease and disease progression and unable to monitor population trends and inequalities in dietary access in order to design effective policy interventions. We argue that the current lack of routine screening for food insecurity is inconsistent with our approach to other health behaviours (eg, smoking and alcohol use), as well as with doctors’ frequent informal role as gatekeepers to the food aid system, and recent calls for governmental action on food insecurity and health inequalities from individual clinicians and professional bodies. Potential ethical barriers to asking patients about food security are addressed, including concerns about stigma, limiting autonomy, fair resource allocation, unclear professional remits and clinicians’ ability to offer effective interventions. We suggest that there is an ethical imperative for doctors to ask patients about their ability to access healthy food. Gathering this data provides a valuable first step in re-framing the social determinants of health as modifiable risks, rather than inevitable inequities.
- ethics
- education for health care professionals
- health promotion
- social aspects
Data availability statement
No data are available.
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
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Data availability statement
No data are available.
Footnotes
Twitter @drzoefritz
Contributors JKK and ZBMCF conceived of the idea for the article. JKK conducted a review of other articles and wrote the first draft. ZBMCF wrote additional sections. ZBMCF and JKK both contributed to subsequent and final drafts.
Funding This study was funded by Wellcome (Grant no. 208213/Z/17/Z); University of Cambridge; Health Foundation.
Competing interests JKK is a medical student and one of the directors at Oxford Mutual Aid, a community support group that provides food parcels and meals to people experiencing food insecurity.
Provenance and peer review Not commissioned; externally peer reviewed.
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