Supporting vulnerable members post-pandemic
Why we still need ongoing support for social determinants of health
September 7, 2021

Feed America projects that by the end of 2021, one in eight Americans will experience food insecurity—including 13 million (or 1 in 6) children. 

Thankfully, there is good news. 

Although the COVID-19 pandemic brought some of the highest rates of food insecurity the country has experienced since the 2008 recession, charitable giving also increased. According to the annual Giving USA Foundation report, charitable donations increased 5 percent in 2020, reaching a total of $471.1 billion in addition to the roughly $391 billion provided through government supported stimulus programs. 

As many of the government protections come to a close, it remains imperative for health plans and providers to continue addressing food insecurity and other social determinants of health. 

Food insecurity prior to COVID-19

Even before the pandemic, 10 percent, or 35 million, of Americans were food insecure—and this was the lowest rate in over twenty years. 

Unaddressed, food insecurity—including lack of access to healthy, nutritious foods and not just cheap calories—has serious health impacts. A 2020 study conducted by the American Heart Association showed that food insecurity contributes to increases in diabetes, cardiovascular disease, and mortality rates.

Food insecurity and race

The same social determinants that contribute to food insecurity—such as education, employment opportunities, income, food and housing stability, and access to healthcare—contribute to an increased risk of chronic illness in many Medicaid populations. In addition, structural racism and discrimination further increase risk of social determinants like food insecurity, with:

  • 9.1% of white individuals experiencing food insecurity
  • 18.9% of Black individuals experiencing food insecurity
  • 15.7% of Latino individuals experiencing food insecurity 
  • 23.5% of Native American individuals experiencing food insecurity

Source: Feeding America


Ongoing efforts to address these social determinants in vulnerable populations will remain key post-COVID-19 as challenges like food insecurity will not disappear after the pandemic. 

A little goes a long way: the impact of smaller cash amounts on health equity

The butterfly effect theory suggests that a small change in initial conditions can create significantly different ultimate outcomes. 

The big pandemic gestures being made to address social determinants through stimulus programs and emergency grants are important to lessening the health equity gap, but smaller gestures can, over time, also work to prompt meaningful change in our low income communities. 

In a 2019 study by University of California Berkeley economist, Edward Miguel, a one-time cash grant “increased total economic activity in the area by $2.60” for every dollar invested. In other words:

Doing what we can right now, even if it seems small, can still prompt meaningful change in the lives of our low income communities.

Creating patterns for lasting behavior change 

Wellth leverages behavioral economics to support its members in building healthy habits, one day, decision, and smartphone check-in at a time. 

With Wellth, members are offered a monthly reward—which can be used to buy groceries, cover utilities, pay rent or make home repairs, or meet other needs—for adhering to prescribed care plans and documenting that adherence via their smartphone. Each day that members check in, they are able to keep their reward for the day. Each day they miss it, they lose a portion of their monthly reward. 

While the reward varies on the program, even smaller reward values have proven helpful for these individuals. As one Wellth member shares: 

“It really helps to know that the Wellth rewards are there at the end of the month—almost like a safety net—and I can use it for groceries, gas or medication.” 

-Wellth member

And unlike one-time cash grants, programs like Wellth provide ongoing opportunities for individuals to earn rewards as they work to form healthy habits a day at a time. Over time, this not only eases financial strain, but as members successfully change their habits, they learn to feel ownership of their health and maintain their good habits even after the program ends. 

Improving health equity now

While the COVID-19 pandemic has been devastating across many fronts, it has exposed the impact that social determinants have on health—not only in increasing risk of infection, but in increased risks of chronic conditions, mental health diagnoses, and other complications. 

By committing to start now, even with small amounts like $30 a month, we can make a difference. 68 percent of Wellth members use their rewards for food and groceries, with the other members using them for other necessities—such as housing upkeep, transportation, and more. 

“Not only have I taken my medication, I have also been able to keep a job, to keep my apartment, to keep my lights on, to keep food in the refrigerator. It’s just with me taking my meds, I get to live a full life.”

-Wellth Member