Report on Food Insecurity, Mortality in Cancer Survivors, and Sustainable Development Goals

A national study reveals a significant association between food insecurity and premature mortality among cancer survivors. This report analyzes the study’s findings, emphasizing their direct implications for several United Nations Sustainable Development Goals (SDGs), including SDG 2 (Zero Hunger), SDG 3 (Good Health and Well-being), and SDG 10 (Reduced Inequalities).

Study Methodology

The research was conducted by analyzing data from two national surveys:

• National Health Interview Survey (NHIS)
• National Death Index (NDI)

The analysis covered the period from January 2011 to December 2019 and included a cohort of 5,603 cancer survivors. The objective was to investigate the links between food insecurity, mortality (all-cause and cancer-specific), and the mitigating effect of food assistance programs, while adjusting for various demographic and socioeconomic factors.

Key Findings and Implications for Sustainable Development Goals

SDG 3: Good Health and Well-being & SDG 2: Zero Hunger

The study establishes a direct challenge to achieving SDG 3 by demonstrating that a lack of access to nutritious food, a core component of SDG 2, leads to adverse health outcomes for a vulnerable population.

• Over a median follow-up of 7.6 years, 1,556 deaths occurred.
• Cancer survivors experiencing food insecurity had a significantly higher risk of all-cause and cancer-specific mortality.
• This increased risk persisted even after controlling for age, socioeconomic status, health behaviors, and pre-existing medical conditions.
• The findings underscore that access to nutrient-dense food is a critical component of comprehensive cancer care and survivorship, linking the goals of Zero Hunger (SDG 2) and Good Health (SDG 3) inextricably.

SDG 10: Reduced Inequalities & SDG 1: No Poverty

The research highlights critical inequalities in health outcomes driven by income-based eligibility for social safety nets, which directly relates to SDG 10 and the broader context of SDG 1.

1. Protective Effect of Assistance: Among households receiving food assistance (e.g., SNAP, WIC), the link between food insecurity and increased mortality was not present. This demonstrates that social support systems are effective in mitigating health disparities.
2. The “Eligibility Gap”: A significant finding was the vulnerability of cancer survivors with household incomes at or above 200% of the Federal Poverty Level (FPL). This group, often ineligible for federal food assistance, still experienced food insecurity and a corresponding higher risk of death.
3. Income and Access Disparity:
   • 54% of individuals with incomes below 100% of the FPL received food assistance.
   • Only 17% of those between 100% and 200% of the FPL received assistance.
   • Just 2% of those with incomes above 200% of the FPL received assistance.

This “eligibility gap” creates a profound inequality where individuals considered “too rich” for aid are left vulnerable, undermining the core principle of SDG 10 to reduce inequalities within and among countries.

Study Limitations and Recommendations

Limitations

• Cancer diagnoses were self-reported.
• Food security was measured at a single point in time.
• The dataset lacked detailed clinical information like cancer stage or treatment history.

Recommendations for Action

Despite limitations, the evidence strongly supports immediate action to align healthcare practices and public policy with the SDGs.

1. Clinical Practice Reform: Healthcare providers and national societies should recommend routine screening for food insecurity as a standard of care for cancer patients. This directly supports SDG 3 by integrating a key social determinant of health into clinical practice.
2. Patient Referral Systems: Upon screening, patients should be referred to community resources, food banks, and registered dietitians to ensure access to nutritious food, advancing the goal of SDG 2.
3. Policy Advocacy for SDG 10: The findings provide a clear mandate for policy change. Policymakers should advocate for expanding income eligibility criteria for federal food assistance programs like SNAP to close the gap that leaves many cancer survivors vulnerable. This policy reform is essential for reducing health inequalities and making progress toward SDG 10.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

1. SDG 2: Zero Hunger
   • The article’s central theme is “food insecurity,” defined as a “lack of access to nutrient-rich food.” It directly addresses the challenge of ensuring people, specifically a vulnerable group like cancer survivors, have access to nutritious food.
2. SDG 3: Good Health and Well-being
   • The article connects food insecurity directly to health outcomes. It discusses how a lack of nutritious food is “associated with early mortality among cancer survivors” and increases the “risk of death from cancer or from all causes.” This highlights the critical link between nutrition and health for individuals with non-communicable diseases like cancer.
3. SDG 1: No Poverty
   • The article examines the role of poverty and income in accessing food and social support. It uses the “Federal Poverty Level (FPL)” as a key metric and discusses how income thresholds determine eligibility for food assistance programs, directly linking poverty levels to health and survival.
4. SDG 10: Reduced Inequalities
   • The article highlights a significant inequality in health outcomes based on socioeconomic status. It shows that cancer survivors with incomes just above the eligibility thresholds for assistance (“too rich for help, but still food insecure”) are at a higher risk of death. This points to a systemic inequality where social safety nets do not cover all vulnerable populations equally.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 2.1: End hunger and ensure access to safe, nutritious and sufficient food
   • The article focuses on the need for “access to nutritious food” for cancer survivors. The study’s finding that food insecurity is linked to early death underscores the importance of ensuring this vulnerable group has access to sufficient, nutrient-dense food year-round.
2. Target 3.4: Reduce by one-third premature mortality from non-communicable diseases
   • Cancer is a non-communicable disease. The article demonstrates that food insecurity leads to “increased risk of cancer-specific and all-cause mortality” and “early death.” It also shows that food assistance can mitigate this risk, positioning nutritional support as a key factor in reducing premature mortality from cancer.
3. Target 1.3: Implement nationally appropriate social protection systems
   • The article explicitly analyzes the impact of social protection systems like “SNAP or WIC.” It shows that “cancer survivors who got support from programs like SNAP or WIC didn’t face that same increased risk” of mortality, highlighting the effectiveness of these systems. It also calls for policy changes to “expand income eligibility criteria for federal food assistance programs,” advocating for strengthening these social protections.
4. Target 10.3: Ensure equal opportunity and reduce inequalities of outcome
   • The study reveals an inequality of outcome, where food-insecure cancer survivors with incomes “at or above 200% of the Federal Poverty Level (FPL)” have an increased risk of mortality because they do not qualify for assistance. The article’s recommendation to expand eligibility for food assistance programs is a direct call to action to reduce this inequality and ensure more equal health outcomes.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. Prevalence of food insecurity (Indicator for Target 2.1)
   • The article explicitly measures and discusses “food insecurity.” It states that “between 17% and 55% of people diagnosed with cancer qualify as food insecure,” providing a direct indicator of the scale of the problem within this specific population.
2. Mortality rate from non-communicable diseases (Indicator for Target 3.4)
   • The study uses mortality as a primary outcome measure. It reports “1,556 deaths from all causes” over the follow-up period and analyzes the “cancer-specific and all-cause mortality” rates in relation to food security status. These mortality rates are a direct indicator of progress toward reducing premature death from cancer.
3. Proportion of population covered by social protection systems (Indicator for Target 1.3)
   • The article provides specific data on the coverage of food assistance programs based on income. It states that “54% of individuals with incomes below 100% of the FPL received food assistance, compared to only 17% of those between 100% and 200% of the FPL.” This data serves as an indicator of the reach and limitations of current social protection systems.
4. Mortality risk stratified by income and access to social programs (Implied Indicator for Target 10.3)
   • The article implies an indicator for inequality by comparing mortality risks across different groups. The finding that “food insecurity was linked to a higher risk of both cancer-related and overall mortality” specifically among households “not receiving food assistance” and those with higher incomes (above 200% FPL) serves as a powerful metric for measuring health inequality.

4. Table of SDGs, Targets, and Indicators

Source: ldi.upenn.edu