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Nutrition for Nurses

1.4 Vulnerable Populations

Nutrition for Nurses1.4 Vulnerable Populations

Learning Outcomes

By the end of this section, you should be able to:

  • 1.4.1 Assess the impact of food insecurity on health and food choices.
  • 1.4.2 Describe ways to promote food security.

Social Determinants of Health

Nurses must consider that clients’ health problems can be affected by nonmedical factors. Individual clients are part of larger groups whose health is affected by social, demographic, and environmental forces. Unfortunately, certain populations are more likely to experience negative health outcomes related to these influences.

Social determinants of health (SDOH) are nonmedical factors that affect individuals’ health (USHHS, 2021; ODNPHP, n.d.). Examples of SDOH include the following:

  • Safe housing, transportation, and neighborhoods
  • Racism, discrimination, and violence
  • Education, job opportunities, and income
  • Access to nutritious foods and physical activity opportunities
  • Polluted air and water
  • Language and literacy skills

One of the goals of Healthy People 2030 is to address SDOH and create social, physical, and economic conditions that promote health and well-being for all.

Food Insecurity

Food insecurity is access to nutritious foods that is limited or uncertain because of social or economic factors (National Institute on Minority Health and Health Disparities [NIMHHD], n.d.). Clients with food insecurity do not have consistent, reliable sources of nutrient-dense foods. Poverty, long-term health conditions, and racial discrimination are some of the factors that can lead to food insecurity (Feeding America, 2023). In 2020, almost 15% of U.S. households experienced food insecurity at some point in time (NIMHHD, n.d.). Nurses should screen clients for food insecurity as part of a nutritional assessment.

Special Considerations

Food Insecurity

As part of a nutrition assessment, clients should be screened for food insecurity. The USDA has a Household Food Security Survey (HFSS) that can be used. However, researchers have developed a brief two-question tool based upon the HFSS that can be used to quickly screen clients. The Hunger Vital Sign includes two statements that can be read during a client interview; the client should respond to each statement as “often true,” “sometimes true,” or “never true” for their household in the last 12 months. If the client responds “often true” or “sometimes true” to either question, the screening for food insecurity is positive.

  1. “We worried whether our food would run out before we got money to buy more.”
  2. “The food we bought just didn’t last, and we didn’t have money to get more.”

The Hunger Vital Sign screening is easy to use and is increasingly being built into electronic health record systems (Gattu et al., 2019).

Impact on Health and Food Choices

Local environments influence food insecurity significantly (NIMHHD, n.d.). For example, food deserts are geographic areas that lack access to affordable, healthy food. These can be rural or urban areas that lack grocery stores with healthy food options. In some areas, there may be stores that sell food, but the food is not nutritious. Food swamps are areas with stores that sell food, but the food is high in calories, sugar, sodium, and/or fat—often referred to as junk food.

When people do not have reliable, nutritious food sources, they cannot follow recommended diets. As such, food insecurity is associated with poor health outcomes. People with food insecurity are at increased risk for long-term health conditions, including diabetes, obesity, and heart disease (NIMHHD, n.d.).

Promoting Food Security

Food security means having enough food for an active, healthy life (NIMHHD, n.d.). Promoting food security necessitates educating and referring clients to additional resources (Hunger + Health, 2023). Food literacy—understanding labels and making good food choices—is critical to improving food security (Devine & Lawlis, 2019). Sometimes the client can access adequate quantities of food, but it is not quality, nutrient-dense food. For example, the client may eat a lot of fast food or junk food from a convenience store. Although education is essential to improving the client’s diet, education alone is not enough. The client needs access to the types of foods recommended through client teaching. Nurse referrals to community agencies for food and other financial assistance are essential.

Vulnerable Populations

Some groups in the U.S. are considered vulnerable populations because nonmedical factors limit their ability to achieve health and wellness (CDC, 2022b). Examples of vulnerable populations include racial or ethnic minority groups, low-income groups, migrants, older adults, and children. When assessing clients, nurses should consider whether they are part of a vulnerable population and plan interventions accordingly.

The County Health Rankings & Roadmaps (CHR&R) provide data to raise awareness of factors that influence health in a community. This information is available for anyone to access. Nurses can use this information to learn more about the clients they treat. Communities can use the information obtained from these rankings to promote health equity and improve the overall health of their citizens. The CHR&R model identifies SDOH and how they relate to citizens’ health factors. Communities can develop policies and programs to influence these health factors that influence health outcomes.

Special Considerations

Connect Health Literacy and Health Equity

Teaching nutrition using resources and strategies that address health literacy needs also promotes health equity. Teach clients in a way that matches their cultural, language, and environmental needs, so they are more likely to understand and accept what is being taught (USHHS, 2021). Health literacy can make information easier to understand and health equity can make the information more inclusive.

County Health Rankings

How healthy is your community? Review health data for any county in the U.S.—visit the County Health Rankings & Roadmap website and search by state, county, or zip code to obtain health data for a community of interest. Compare health-related metrics in a location of interest with metrics from other locations. The database includes several nutrition-related metrics, including obesity rates, food environment index, excessive drinking, access to health care, and other SDOH.


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