Hospitals and health systems are expanding their visions of population health to include more effective approaches to manage – and even fend off – chronic diseases and conditions. In fact, many institutions are successfully applying their expertise in community health to help people stay out of the hospital by addressing key social determinants of health such as food insecurity. In doing so, they are hoping to demonstrate that by improving access to healthy food and nutrition, they can positively impact chronic conditions like diabetes, obesity and hypertension, while reducing overall healthcare costs.
Food insecurity is widespread around the nation. According to the U.S. Department of Agriculture, about 38 million Americans did not have enough food to meet their needs in 2020, profoundly affecting their health and quality of life. Moreover, “eating a healthy breakfast is associated with improved cognitive function, reduced absenteeism in schools and improved mood,” said Dr. Kara Odom Walker, executive vice president and chief population health officer at Nemours Children’s Health System, during a recent U.S. News & World Report webinar. Addressing all of these concerns is a priority for Nemours, she noted, which embraces a “whole child health” model that incorporates “nutrition and food access as an essential part of health.”
Children, indeed, are where “the biggest opportunity is” for effecting change, said Dr. Lisa Harris, CEO of Eskenazi Health, a public hospital located in Indianapolis. She noted that “it's an unfortunate truth” that the strongest predictor of health and longevity is ZIP code. Her health system focuses on “the short-end-of-the-stick ZIP codes” because “low-income individuals [bear] a disproportionate burden of chronic disease,” Harris said. “The research has borne out that 80% of chronic disease can be prevented, better managed and, in some cases, even reversed by focusing on nutrition and physical activity. This requires, though, the access, for example, to healthful food and stable, safe environments be available to all, not just the fortunate few.”
Pamela Schwartz, executive director for community health at Kaiser Permanente, an Oakland, California-based health organization, referenced a 2020 survey of some 10,000 of its members, which revealed that nearly a third reported food insecurity, and would welcome assistance. “So we've been building a robust portfolio to address our members’ social needs, starting with food insecurity,” she said. In addition, “we've been building a comprehensive national approach to really transforming the economic, social and policy environments that are related to food, so that people across the nation can have access to healthy, affordable food.”
Intermountain Healthcare, a Utah-based health system that serves western states, created a pilot program in two counties to map and address social needs in order to reduce medical spending and improve quality of life. “We uncovered some of the barriers that were in the way of trying to meet people's needs,” including food insecurity, noted Mikelle Moore, the system’s senior vice president and chief community health officer. “We now screen all of our patients for social needs and are able to connect patients and members to food” and other assistance programs, she said. Analytics can also “help us predict who needs to be outreached, because we're not always encountering the people who are in the most need” in the clinic, she added.
The COVID-19 pandemic only exacerbated an already existing problem of food insecurity. Schwartz said Kaiser Permanente ramped up its outreach program to help members apply for Supplemental Nutrition Assistance Program benefits through an “innovative, inexpensive texting approach” to reach individuals in low-income communities. “To date, we've reached over 4 million members and assisted 95,000 members to apply for SNAP, and we also estimate that this kind of a simple texting campaign has put more than $34 million into our members’ pockets and nearly $50 million into the local economies,” she said.
Moreover, individuals “appreciate being asked if they have a need,” Moore said. “As soon as they're asked, there's almost this wave of appreciation that we consider this an aspect of health and that we would be so caring as to ask about aspects of their home life,” such as food and housing. “The harder part for us has been really convincing our caregivers how to get comfortable with asking the question. That's taken some training and coaching to help people know how to ask those questions.”
Intermountain uses a tech platform called Unite Us that allows caregivers to connect a patient to social services, whether those are food-based or related to other needs. “I think this is the future,” Moore said. “We all do our part in managing a network of skilled nursing facilities and therapists and hospitals and clinics to help support our patients in numbers. This is the beginning of a social network that will be a really important part of managing health in the future.”
Healthcare systems are also finding creative ways to use their space to reinforce their missions. At Nemours, which has two children’s hospitals and facilities in Delaware, New Jersey, Pennsylvania and Florida, “one of the programs that we have established is our Can Grow Garden, which is actually a program on our campus that's designed to help empower more families” to do the same at home.” The program features raised beds outside the cafeteria that serve as a demonstration garden to show families how to grow their own produce. “I remember meeting a young woman who said, ‘I never knew what kale was. I never knew kale tastes so good,’” Walker said, “and I think that's just the power of learning as you experience life as you see it grow with your own hands and your own watering.”
Harris then recounted a story that captured viscerally what living with hunger can be like for kids At a neighborhood health center, the waiting room was disrupted one day when a young boy kept chasing another child. The doctor on hand later learned the reason, Harris noted. The boy “was hoping the [other] child would drop some of the Doritos out of the bag that he was carrying, because this young boy had not eaten for two to three days. So that's when you really start to think about what that feels like,” and it ignites “this passion to do something.”
This incident triggered the creation of Eskenazi’s Crooked Creek Food Pantry, a nonprofit, full-service facility located within the health center. Private providers can screen individuals and offer a “food-as-medicine prescription” for the pantry which offers the items they need, Harris said. “It provides an important advantage in terms of convenience [and] in reducing [the] stigma of having to go somewhere else for food.”
The panelists said research efforts to assess the value of these initiatives are underway. These include well-designed studies to examine factors like the duration of meal delivery, the number of meals provided per day and which disease categories are impacted.
Money is, as always, a challenge. “It obviously takes funding on a large scale” to provide these services, Harris said. Funds often come from a combination of federal and local grants, corporate sponsors, faith-based organizations and individual donors, including the Emergency Food Assistance Program, a federal program initiated during the pandemic. “Unfortunately, we don't know how long this benefit will continue, and one of the potential sustainability challenges is just going to be adjusting to a decrease in that support,” she said. “The hard truth is that we all struggled to fund these programs, and the long-term sustainability is going to depend on payers’ or society’s willingness to pay.”