Rochelle, an M Health Fairview patient in Minnesota, was struggling to manage all of her different medications. Her doctors saw that her condition could be improved with access to fresh foods, and so they referred her to the VeggieRx program. Through VeggieRx, Rochelle received fresh produce and was able to not only improve her own health but also the health of her family. VeggieRx program recipients are able to eat healthy, manage chronic conditions, and even prevent diseases like diabetes. M Health Fairview sources the produce from the Hmong American Farmers Association so that they are able to support the local immigrant farming community while providing fresh food to patients in need (HAFA, 2019).
Hospitals and health systems recognize the impact of food security on overall health and wellbeing. When people are unable to access or afford healthy food, they are at an increased risk of health issues like heart disease and often struggle to manage chronic conditions like diabetes. HAN health systems know that food insecurity has ripple effects throughout the community and that anchor institutions need to invest in better food options and confront the root causes of food insecurity in order to improve health outcomes and community wellbeing.
Food insecurity is widespread across the US, and disproportionately impacts low-income communities, people of color, and families. In 2019, 10.5% of US households were food insecure (USDA, 2019), and experts expect the percentage of food insecurity to continue to increase as millions of families struggle during the pandemic (Feeding America, 2020). Food insecurity is not only devastating for the individuals it impacts, but is expensive for hospitals and society at large. In 2014 alone, the healthcare costs of hunger and food insecurity was estimated to be $160 billion – a number many experts believe to be conservative (Hunger Report). More Americans are sick than healthy with half of adults having diabetes or prediabetes and more than half with cardiovascular disease, and 3 in 4 adults with obesity or are overweight, (Tufts Friedman School of Nutrition Science and Policy, 2021). Food insecurity and hunger are linked to concerns like increased hospitalizations, mental health concerns, heart problems, and diabetes, which is why combating food security is not only a moral imperative but also a smart business decision.
As health systems acknowledge the importance of food access in creating healthy communities, many are providing their own food programming. One popular approach is hosting a food bank within a hospital, so that patients are able to access fresh produce to care for their health concerns just as they would normally access the pharmacy. With these programs, doctors are often able to write a “prescription” for free food from the hospital food bank so that patients can more holistically care for their health. Some of these programs also incorporate educational programming, like workshops with dietitians and cooking classes that showcase healthy eating options from cuisines around the world. Other health systems strive to make fresh produce available to the wider community and open farmers markets, often accepting WIC and SNAP benefits so that all community members can access healthy food.
Many people who face hunger or food insecurity struggle because of things like low wages, unemployment, or lack of fresh food availability. Programs that provide food prescriptions and healthy food baskets serve an immediate community need, while programs that integrate providing emergency food assistance with things like job training or employment options tackle the root causes of food insecurity. ProMedica, for example, has prioritized targeting the foundations of food insecurity with their Ebeid Neighborhood Promise. As part of this program, ProMedica opened Market on the Green, a 6,500 square foot grocery store that offers affordable and healthy food to low-income neighborhoods in Toledo. This grocery store is not only offering healthy food options in neighborhoods often overlooked by major grocers, but they are also using the Market on the Green to employ local residents and strive to source food locally. Ebeid Neighborhood Promise also recognizes the holistic nature of food insecurity, and has launched an affordable housing, job training, and financial coaching program to complement Market on the Green (Next City, 2020). ProMedica has also co-founded the Root Cause Coalition, which works to leverage the healthcare sector’s collective impact to fight health inequities and the social determinants of (ill) health through advocacy, education, and research.
Other health systems, like VCU Health System, have taken a similar holistic approach to health. VCU Health System serves neighborhoods with high poverty rates that often lack affordable produce, and so a solution would require looking at the intersections between health, poverty and food insecurity. VCU Health System and Virginia Commonwealth University jointly fund and operate the VCU Health Hub at 25th, which is located next to the local grocery store Market@25th and addresses these intersecting needs. This Health Hub promotes both individual and community health by providing access to services like health education and care coordination. The neighboring grocery store, like Market on the Green, also strives to employ local residents and sources food locally when possible. Understanding that food insecurity may be one of several root causes of poor health outcomes, VCU Health System has also made investments in areas like affordable housing (Next City, 2020). Housing and food insecurity are interconnected, and when people struggle to afford their rent or mortgage, one of the first expenses cut from the budget is food. By investing in affordable housing, VCU Health System is helping to make that impossible choice unnecessary.
Employing local residents and sourcing foods locally is an important way of building community wealth so that community members are able to both afford and access healthy food options. At the aforementioned Market@25th, for example, 90 percent of employees are local community members who are paid above average wages (Richmond Free Press, 2020). As these employees and local residents earn more, they are able to better provide for themselves and their families, whether that means being able to afford healthy food or being able to pay rent. M Health Fairview has also made a commitment to sourcing locally, such as with their food basket program where they source their food from the Hmong American Farmers Association (MPR News, 2019). This community investment has become particularly important as low-income communities and people of color are disproportionately impacted by COVID deaths and job loss; M Health Fairview has continued to distribute food throughout the community, and is now also sourcing from local producers who faced a decline in demand after the closing of restaurants. M Health Fairview is providing a crucial lifeline to struggling residents while building community wealth with their sourcing from local businesses, especially those most impacted by COVID.
Health system food supply chains can be another way to build community wealth and tackle the root causes of food insecurity. Kaiser Permanente, for example, hopes to buy all of their food locally or from farms and producers that use sustainable practices by 2025. With this local sourcing initiative they are also hoping to provide employment and economic opportunity for low income communities and communities of color, especially local residents who may face barriers to employment (HAN, 2020). Cleveland Clinic and University Hospitals also use their own health system food needs in order to support their community. They source some of their produce from Evergreen Cooperatives’ Green City Growers, which is a locally-staffed, worker-owned company and food-production greenhouse (Green City Growers). These initiatives are able to serve a dual purpose of providing fresh produce to patients and health system workers while also investing in the community.
With food insecurity on the rise, many health systems are looking for ways to support their communities in times of crisis while investing in long-term upstream solutions, including community wealth building. COVID-19 has highlighted racial disparities in healthcare outcomes and put renewed focus on the impact of upstream determinants of health. Communities of color have been disproportionately impacted by the virus and face higher infection and death rates, in part because of health disparities that are impacted and exacerbated by unequal access to fresh and affordable food. These communities are also facing higher unemployment rates, which means less money for households to spend on food. This has had a devastating impact on families with children in particular. In June 2020, three in ten Black households with children were experiencing food insecurity, as well as one in four Hispanic households. White households with children report a food insecurity rate of under 10% during that same time period (Brookings, 2020). The root causes of food insecurity, and their disproportionate impact on communities of color, necessitates long-term and sustainable community investments that focus on empowering local residents and building community wealth.