In Response to “Assessing Food Insecurity in Medical Students”

I applaud Flynn and colleagues for identifying an underdiscussed topic in their article titled “Assessing Food Insecurity in Medical Students.”1 While there is growing literature, awareness, and interest in global food insecurity, rarely is the lens turned inward. Medical students represent a vulnerable population given their low income and rising cost of medical education (the median debt at graduation increased $142,000 in 25 years even after adjustment for inflation).2 Interestingly, the researchers found that the prevalence of food insecurity at the Warren Alpert Medical School of Brown University to be similar to the general population (11.8% vs 11.1%). Especially with the COVID-19 pandemic and its ensuing financial stressors, it’s important to identify underlying causes for food insecurity in medical students.

First, it should be noted that the prevalence of food insecurity of those with a college education or higher is 5%.3 Compared to this, medical students have more than double the expected rate. Despite going through rigorous undergraduate education, many medical students are not employed as they complete graduate school and instead continue to accrue debt. Of course, medical students can expect a salary much higher than most college graduates as attending physicians. However, this takes several years and, in the meantime, the burden of food insecurity is not to be underestimated. Food insecurity has well-studied, long-term detriments to both physical and mental health as well as academic outcomes.4,5 This impacts quality of medical training, wellness, and burnout and adds financial pressure to pursue some specialties over others. Even if food insecurity may be transient in medical students, its effects are not.

Secondly, the most commonly reported reason for food insecurity in the studied population was being unable to get to a store that sold the food that they wanted (33.96%). The authors astutely pointed out that the school was situated in a food desert, defined as no supermarket with nutritious foods within 0.8 to 1.6 km.6 However, literature shows that living less than 1.6 km from a supermarket with nutritious food was not associated with increased self-reported food security. One study in Pittsburgh, Pennsylvania found that while the average distance to a supermarket was 2.6 km, the average respondent traveled 6.0km.7 United States Department of Agriculture (USDA) data shows that 64% of people bypassed the closest supermarket for a primary food source of greater distance.8 A common reason reported was low prices. Even if there were a nearby supermarket, access to affordable food may not be provided.

Additionally, the USDA data and similar studies found an association between food insecurity and having a personal automobile.9 Anecdotally, many medical students do not have access to a personal automobile for various reasons including cost and relocation. A combination of needing lower food prices and lack of a personal automobile is a dangerous combination for medical students.

Food insecurity is a significant barrier to health equity, and medical students are particularly vulnerable. Food insecurity has decreased in the last decade to match levels before the 2007 Great Recession. However, with the economic implications of the COVID-19 pandemic looming on the horizon, it is crucial that causes of food insecurity in medical students are identified so that medical schools can support and protect the future of our frontline forces.