Analyzing Meals on Wheels: A Social Determinant of Health Intervention

This report examines the 'Meals on Wheels' program as a critical intervention addressing social determinants of health, specifically food insecurity, nutrition, and social support for vulnerable populations, particularly the elderly. It begins by defining social determinants of health and their impact, then introduces the Meals on Wheels organization, detailing its mission to provide nutritious meals and support to seniors. The report reviews existing literature, highlighting the positive effects of the program on dietary adherence, quality of life, and combating social isolation. It analyzes how the service influences health outcomes by providing statistical data from Texas and other sources. The report then offers recommendations to enhance the program's effectiveness, advocating for broader accessibility, and improved staff training. The conclusion emphasizes the importance of nutrition, economic stability, and social connection in overall health and the role of Meals on Wheels in promoting equity, and making the service available in nursing homes and aged care facilities.

Running head: SOCIAL DETERMINANTS OF HEALTH
‘MEALS ON WHEELS’: SOCIAL DETERMINANT OF HEALTH
Name of the Student
Name of the University
Author note

1SOCIAL DETERMINANTS OF HEALTH
Introduction
Social determinants of health are conditions in which an individual is born, grown, learn,
live, work, age and dies. These determinants affects several aspects of that individual’s life such
as health outcomes, quality of life, and ability to grow both mentally and economically. These
determinants also affects the sense of security and wellbeing of the people (World Health
Organization, 2014). Depending on these determinants, the money, resources and power is being
distributed to local, national and international levels. However, the most common disparities in
social determinants of the health are being observed in the matter of health. The prime difference
that leads to disparities regarding to health in countries are resources and availability of nutrition,
resourceful markets and social support (Riekert, Ockene & Pbert, 2013). Therefore, the chosen
social determinant of health is food insecurity influenced by inadequate health, nutrition and
social support.
The major social determinants of health is influenced by several factors such as the place,
the state and the environment, genetics, income and education level and so on. Higher income
and better education leads people to avail better health choices and better nutritional options
however, illiteracy and lower socio-economic status let people fall sick due to malnutrition or
having less knowledge about the nutritional requirement for our body (Allen et al., 2014). Hence,
this critical assessment is going to discuss an influencing factor of the major social determinant
of health, nutrition and social support with the help of a service called ‘Meals on Wheels’.
Further, with the help of evidences will describe the way this influencing factor affects the health
of population. Further, according to the data analysis, this discussion will point out few
recommendations that need to be made to make this service more effective.

2SOCIAL DETERMINANTS OF HEALTH
The organization and service
The ‘Meals on Wheels’association of America is the oldest and largest national
community based nutrition program. The organization ‘Meals on Wheels’America is a non-profit
organization that provides the senior citizens of America with their quality services. The prime
aim of this organization is to serve all the American senior citizen with nourished lives with
dignity and independence. Their sole mission is to empower different local communities with
nutritious food so that they could spend their life with ease and comfort. The service has a
glorified history of serving more than 5000 community based nutrition organizations across the
states. The organization not only delivers for the hunger of the food, but provides aid or funding,
leaderships and education or advocacy support to people in need and helps to empower the entire
community associated with that person. There are nearly more than two million volunteers
attached with the organization (Meals on Wheels America, 2017). This food service, Meals on
Wheels provides food to socially isolated older people for improving their physical health
addressing the issue of food insecurity. It also supports those aged people who are unable to cook
ensuring food security and addressing social isolation.
The oldest service of ‘Meals on Wheels’ was originated in the United Kingdom during
the Blitz. This was a very tough time for the entire population as trillions of people were
homeless and unable to cook their food. Then a group of females started cooking for them.
However, the name was coined during the world war two and involved people who are aware of
social determinant of health and the importance of nutrition. Currently, this service is serving in
countries like Australia, Canada, Ireland and the UK.

3SOCIAL DETERMINANTS OF HEALTH
Literature review
From the very beginning, efforts that have been made to positively affect the healthcare
system and health outcome in America have been determined as the key enhancer of health.
However, according to the research, improving the population health and achieving equity is also
important to enhance the health if population. This is done as such interventions affect the social,
economic, and environmental factors that enhances the health of population. ‘Meals on Wheels’
is one such program driven to empower the seniors of different communities who are struggling
for their food, nutrition and health. According to the Zhu and An (2013), the research they
conducted was to identify impact of home delivery food or ‘Meals on Wheels’ service on the diet
and nutrition of the older population. The result that they observed after the study was very
positive about the service. The service reduces the food insecurity and nutritional imbalance
across population and improved their dietary adherence and quality of life. According to the
Texas fact sheet, there are 927556 older population, who are isolated or living alone, 771,830 are
suffering from hunger and more than 1 million are suffering from near poverty. According to
Theeke et al., (2012), meals on wheels, services have helped to support those seniors in such a
way that they are able to live their life on their own. They are now been able to have food
depending on their nutritional requirements helping to serve other elders as well by accepting the
self-volunteering option.
According to Boulos, Salameh & Barberger‐Gateau, (2017) due to social isolation, there
is high risk for malnutrition among the elderly population. Loneliness is an emerging issue
among the older population that has severe impact on their health, nutritional status. The results
of the study suggested that elderly people above the age of 65 years suffer from malnutrition due
to inadequate nutritional care. This is a major emerging clinical and public health issue that

4SOCIAL DETERMINANTS OF HEALTH
requires immediate action and it depicts that malnutrition can affect the growth and wellbeing of
elderly people and therefore, the ‘Meals on Wheels’ service becomes very important for the
population.
How the service influences the social determinant of health
Absence of a healthy diet can force the population to suffer from cancer, obesity,
hypertension, diabetes and other chronic health conditions. According to Mourshed and Zhao
(2012), the healthcare campaigns and promotional events can influence a section of population
who are connected to that service however, the entire population especially elderly people are
not aware of it. Therefore, it leads them to suffer from different health disorders and affects the
social determinants of health of that state and community. Furthermore, health promotion camps
can prevent the disease; success can be enhanced if the influence can be spread to the entire
population. ‘Meals on Wheels’ service helps to enhance this aspect of the community and helps
to educate everyone about need of nutrition and health to lead a healthy life. As their first
priority, they provide food to elders, who are isolated or not able to prepare their food and then
helps them to educate others as well (Marmot et al., 2012).
The effect of this service on the social determinant of health can be evidently understood
by the statistical data of Texas, where this service is dedicated to the older people who are unable
to cook for themselves. According to the statistical data of Texas, more than 20 percent of senior
adults are at the risk of hunger, which is sixth in the complete United States of America. ‘Meals
on Wheels’ service help these elders by providing them home delivery of nutritious food, within
which, 70 percent are women living alone and suffering from loneliness, or isolation from the
family. After the survey conducted by the ‘Meals on Wheels ‘organization, 83 percent of people
commented that, the service helped to improve their health and 92 percent accepted that this

5SOCIAL DETERMINANTS OF HEALTH
service enabled them to live the life at their lonely home. On the other hand, 83 percent people
accepted that the service and associated volunteer’s behavior made them feel safe
(MealsonWheelsAmerica, 2017). According to the reports from the ‘Meals on Wheels ‘program
of Tampa, this program helped to reduce the malnutrition among the elderly population and
helped them to gain needed weight. Moreover, the cost of this meal is so low that any population
group, with higher or lower socio-economic status can access the food from this service (Meals
on Wheels America, 2017). According to the journal of the American Diabetic Association, the
cost of this meal for one year is less than the cost of a night spent in private hospital (Campbell et
al., 2015). This statement describes the range of this food service and the wide range of
population that it can affect. Furthermore, one more aspect is affected along with the social and
economic aspect, which is the human connection. As the maximum user of this service are
isolated or living alone on their own, better human connection can enhance their mental health.
Therefore, the volunteers or service delivery people are chosen depending on their behavioral
and relationship developmental skills. This food service can affect the social determinants of the
health by these ways.
Recommendations
In spite of the massive reach of the ‘Meals on Wheels’ service in the communities around
the world, there are few loopholes in the system that are affecting a large section of population.
This section is so much deprived that they are not been able to be a part of this service, due to
racial discrimination, gender based discriminations and so on. Hence, there are few
recommendations that have been made for the betterment of the service. Firstly, the service is
currently for elderly people who are isolated or unable to cook for themselves due to health
disparities or social problems. However, there are many groups or communities of people present

6SOCIAL DETERMINANTS OF HEALTH
in the society, who are neither unhealthy nor elder, but due to some circumstances are unable to
meet their nutritional level. Hence, this service should be for everyone irrespective of his or her
age, race, caste, and health problems (Warburton & Initiative, 2014). The service currently been
serving in developed countries, however, there are communities in developing countries who are
unable to eat for days. Hence, the service should be worldwide, irrespective of need, countries
and should be available seven days a week (Bacsu et al., 2014). Final recommendation will be
about the delivery person. The delivery person or the service provider should recognize the
social role of the task. Therefore, the staff of the service should be provided with training and
communication skills. In my nursing practice, Meals on Wheels can be incorporated where
nurses can include this menu in their clinical rotations or delivered to nursing homes. The food is
highly nutritious; serve the right amount of energy to the elderly population residing in aged care
homes.
Conclusion
The environment in which an individual grows and survival for the living, determines
his/her nutritional need, physical and mental ability and economic stability. These factors are
termed as social determinants of health, which divides the society in socio-economic status,
depending on which; every person can acquire things according to their need. Nutrition is one of
those factors as it not divided among the entire population equally; rich people have better scope
of nutrition than the poor do. This depicts that there is food insecurity in the population defining
economic instability and unequal availability of food. Therefore, to reinforce the equity, ‘a meal
on wheels’ service was coined. As previously discussed, it helped to deliver food to elderly
people who are isolated or unable to cook food according to their need. This service help them to
live freely and with dignity. His section discussed about the service and with the help of

7SOCIAL DETERMINANTS OF HEALTH
literature, recorded the positive impact of this service on populations. Further, the statistical data
from the American service was acquired to provide the influential effect of the service on
population. Finally, the analysis proposed few recommendations to make this service more
effective by introducing it in nursing homes or aged care for elders fulfilling their daily
nutritional needs.

8SOCIAL DETERMINANTS OF HEALTH
References
Allen, J., Balfour, R., Bell, R., & Marmot, M. (2014). Social determinants of mental
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Bacsu, J., Jeffery, B., Novik, N., Abonyi, S., Oosman, S., Johnson, S., & Martz, D. (2014).
Policy, community and kin: Interventions that support rural healthy aging. Activities,
Adaptation & Aging, 38(2), 138-155.
Boulos, C., Salameh, P., & Barberger‐Gateau, P. (2017). Social isolation and risk for
malnutrition among older people. Geriatrics & gerontology international, 17(2), 286-
294.
Campbell, A. D., Godfryd, A., Buys, D. R., & Locher, J. L. (2015). Does Participation in Home-
delivered Meals Programs Improve Outcomes for Older Adults?: Results of a Systematic
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9SOCIAL DETERMINANTS OF HEALTH
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