The Center for Public Integrity

U.S. food aid provides emergency life-saving calories to 46.5 million people around the globe. But with some food emergencies now lingering for years, the USAID food program faces challenges such as nutrient deficiencies, higher costs for specialized food supplements and inadequate packaging for rugged conditions during shipment.

Last year, the U.S. government spent almost $2.3 billion to provide 2.5 million metric tons of food aid around the globe. The majority of the funding went to USAID-administered emergency programs, which fed more than 46 million people. USAID estimates demand for food aid will increase by 50 percent in the next 20 years.

The Government Accountability Office found the USAID program designed for food emergencies now spends more than half of its funding to cover multi-year shortages that have become the norm. About 96 percent of the food aid supplied in 2010 went to 21 countries that have received U.S. food aid for four years or more.

During prolonged food shortages, recipients run the risk of developing serious nutrient deficiencies. All food program partners reported at least one nutrient deficiency in their beneficiaries such as iron, Vitamin A and iodine, the report said.

Special, fortified food can be shipped to those most vulnerable -- children under five, pregnant women and women who are nursing. But that food is more expensive, costing up to $0.24 per daily ration, or more than twice as much as the typical grain food rations supplied for short-term emergencies.

“Failure to effectively target more costly specialized food aid products to intended beneficiaries can undermine U.S. agencies’ and implementing partners’ efforts to improve beneficiaries’ nutritional status,” the GAO report said.

Over the past decade, emergency room visits have increased by 11 percent. In 2007, there were approximately 117 million visits to emergency rooms and the number could rise even higher as more people obtain health coverage under the health care reform law, the Government Accountability Office warns.

A portion of these visits, about 8 percent, are for non-urgent conditions, which could be treated in more cost-effective settings like health centers. The average price of a non-emergency visit to the emergency department is seven times higher than similar treatment at a health center, according to national survey data.

On average, seeking any kind of care at health centers is less costly: the average annual expenditure for receiving care at a health center is $3,500, compared to $4,594 for receiving care elsewhere.

Health centers participating in the Department of Health and Human Service’s Health Center Program are private, nonprofit organizations or occasionally public health clinics. Health centers provide a variety of primary care services, including emergency care, regardless of a patient’s ability to pay. A distinguishing factor from hospital ERs is that health centers are required to provide services like case management, translation and transportation, addressing the needs of low-income patients more directly.

 “Lack of awareness of other sources of care, lack of access to primary care and other providers, and financial barriers can contribute to emergency department use, including use for non-urgent conditions,” the GAO said.

Currently, over 1,100 health center grantees operate more than 7,900 sites, serving nearly 19 million Americans.

The Affordable Care Act will provide $11 billion over five years to expand the health care center network, potentially doubling capacity to 40 million patients by 2015.