Addressing the Silent Crisis: A Critical Look at Experiencing Homelessness and Food Insecurity As a Medical Student in the U.S.
Published by: Eboni Anderson, D.H.Ed., Ph.D., M.A, M.Ed., M.S.W.
In recent years, the academic and health communities have begun to shine a light on a pressing, yet often overlooked issue affecting medical students across the United States: homelessness and food insecurity. These challenges, traditionally associated with marginalized populations, are also prevalent among those pursuing careers in medicine, which is a profession dedicated to alleviating human suffering. Undoubtedly, in the medical school landscape, being an unhoused/unsheltered and food insecure medical student can bring about circumstances that necessitate immediate attention. While the journey to becoming a physician is inherently challenging, medical students burdened by these adversities face additional, substantial obstacles. This article explores the prevalence and impact of medical students experiencing homelessness and food insecurity, supported by recent scholarly evidence. Additionally, this piece examines the innovative strategies that medical schools are implementing to address these issues. Drawing upon a foundation provided by the Association of American Medical Colleges (AAMC), this month’s feature article seeks to broaden the dialogue and understanding within the medical school community regarding these critical challenges.
Understanding the Scope of the Issue
Housing instability or being unsheltered, though less documented, is associated with increased indicators of financial hardship. This adds another layer of complexity to the academic pursuits and personal lives of some medical students, as they grapple with these public health-rated challenges.1 The high tuition fees, coupled with the cost of textbooks, equipment, and housing, can lead to situations where students are unable to afford stable accommodation, leading them to couch-surf, live in their cars, or face other forms of homelessness.
Compounding this issue, food insecurity, as defined by the United States Department of Agriculture (USDA), refers to the lack of consistent access to sufficient food for an active, healthy life.2 This is a condition that, alarmingly, affected an estimated 1 in 4 health professions students (i.e., medical, nursing, dentistry, pharmacy, and public health students) at a particular U.S. medical school in 2018.3 These issues pose immediate physical and mental health risks and impede academic performance and professional development, which can potentially compromise the quality of future clinicians.
Economic constraints, exacerbated by the high cost of medical education and living expenses, push a substantial number of medical students into precarious situations where they must choose between basic necessities and their education. As a result, medical students should be recognized as a vulnerable demographic.1 Over the past 25 years, the median debt incurred upon graduation has surged by $142,000, even when adjusted for inflation.4 This ultimately creates an insurmountable financial strain for medical students.
Impact on Student Well-being and Academic Success
The adverse effects of homelessness and food insecurity extend well beyond the immediate challenge of meeting basic needs. For instance, they are associated with significant psychological stress, anxiety, and depression, which can detrimentally impact cognitive function, academic performance, and clinical competencies.5 The stress induced by these conditions contributes to poorer academic outcomes, including lower exam scores and increased risk of academic probation or dropout (attrition) rates, underscoring the need for targeted interventions.6
Strategies for Support and Intervention
Recognizing the gravity of these issues, some medical schools across the U.S. have begun to implement comprehensive support systems aimed at mitigating the effects of homelessness and food insecurity among their students. Initiatives such as campus food pantries, emergency housing solutions, and financial aid enhancements are a few key components of this support network.3 Furthermore, some medical schools have introduced innovative programs like food scholarships and emergency funds, specifically tailored to address the unique challenges faced by medical students.3
Future Directions and Conclusion
The prevalence of homelessness and food insecurity among medical students is a pressing issue that demands a multifaceted approach involving policy reform, community support, and institutional initiatives. As this article highlights, through the concerted efforts of medical schools, non-profit organizations, and policy makers, strides are being made to address these challenges. However, continuous efforts to raise awareness, conduct research, and develop targeted interventions are essential to ensure that all medical students have the opportunity to achieve their educational and professional goals without the burden of being unsheltered/unhoused and food insecure. As future physicians, medical students deserve to pursue their education without the burden of hunger and instability. By ensuring their well-being, we are investing in a healthier future for them and everyone they plan to serve.
References
Ge Y. In Response to “Assessing Food Insecurity in Medical Students.” Fam Med. 2021;53(1):77-77. https://doi.org/10.22454/FamMed.2021.820941.
U.S. Department of Agriculture. Definitions of Food Security. Published October 25, 2023. Accessed March 27, 2024. https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u-s/definitions-of-food-security/#:~:text=Food%20insecurity%E2%80%94the%20condition%20assessed,may%20result%20from%20food%20insecurity.
Balch B. Feeding future doctors: Universities work to alleviate food insecurity among medical students. Association of American Medical Colleges website. Published January 14, 2021. Accessed March 27, 2024. https://www.aamc.org/news/feeding-future-doctors-universities-work-alleviate-food-insecurity-among-medical-students
Pisaniello MS, Asahina AT, Bacchi S, et al. Effect of medical student debt on mental health, academic performance and specialty choice: A systematic review. BMJ Open. 2019;9(7):e029980. https://doi.org/10.1136/bmjopen-2019-029980
Kerman N, Sylvestre J, Aubry T, Distasio J. The effects of housing stability on service use among homeless adults with mental illness in a randomized controlled trial of housing first. BMC Health Serv Res. 2018;18(1):190. Published 2018 Mar 20. https://doi.org/10.1186/s12913-018-3028-7
Goldrick-Rab S, Richardson J, Schneider J, Hernandez A, Cady C. Still hungry and homeless in college. Hope Center for College, Community, and Justice. Published 2018. Accessed March 27, 2024. https://www.bhcc.edu/media/03-documents/voicesofhunger/Wisconsin-HOPE-Lab-Still-Hungry-and-Homeless-April-2018.pdf
