Hospitals and health systems are expanding their vision of population health to include more effective approaches to managing – and even combating – chronic diseases and conditions. In fact, many facilities are successfully applying their community health expertise to help people stay out of hospital by addressing key social determinants of health, such as food insecurity. By doing so, they hope to demonstrate that by improving access to healthy food and nutrition, they can have a positive impact on chronic diseases such as diabetes, obesity and hypertension, while reducing costs. global health care.
Food insecurity is widespread throughout the country. According to the US Department of Agriculture, approximately 38 million Americans did not have enough food to meet their needs in 2020, profoundly affecting their health and quality of life. Additionally, “eating a healthy breakfast is associated with better cognitive function, reduced school absenteeism, and improved mood,” said Dr. Kara Odom Walker, executive vice president. and Population Health Manager at Nemours Children’s Health System, during a recent US News & Global Report Webinar. Addressing all of these concerns is a priority for Nemours, she noted, who adopts a “whole child health” model that incorporates “nutrition and access to food as an essential component of health “.
Children, indeed, are where “the greatest opportunity lies” for effecting change, said Dr. Lisa Harris, CEO of Eskenazi Health, a public hospital in Indianapolis. She noted that “it’s a sad truth” that the best predictor of health and longevity is zip code. Its health system focuses on “short zip codes” because “low-income people [bear] a disproportionate burden of chronic disease,” Harris said. “Research has confirmed that 80% of chronic diseases can be prevented, better managed and in some cases even reversed by focusing on nutrition and physical activity. This requires, however, that access to, for example, healthy food and stable and secure environments is available to all, not just the privileged few.
Pamela Schwartz, executive director of community health at Kaiser Permanente, a health organization based in Oakland, Calif., referred to a 2020 survey of some 10,000 of its members, which found that nearly a third reported food insecurity and would like to receive assistance. “We have therefore built a strong portfolio to meet the social needs of our members, starting with food insecurity,” she said. In addition, “we have developed a comprehensive national approach to truly transform the economic, social and political environments related to food, so that people across the country can have access to healthy and affordable food”.
Intermountain Healthcare, a Utah-based healthcare system that serves western states, created a pilot program in two counties to map and address social needs to reduce medical expenses and improve quality of life . “We discovered some of the barriers that were getting in the way of us trying to meet people’s needs,” including food insecurity, noted Mikelle Moore, the system’s senior vice president and chief community health administrator. “We now screen all of our patients for social needs and are able to connect patients and members to food” and other support programs, she said. The analysis can also “help us predict who needs to be contacted, because we don’t always meet the people who need it the most” in the clinic, she added.
The COVID-19 pandemic has only exacerbated an already existing problem of food insecurity. Schwartz said Kaiser Permanente has stepped up its outreach program to help members apply for Supplemental Nutrition Assistance program benefits through an “innovative, low-cost SMS approach” to reach people in low-income communities. “To date, we’ve reached over 4 million members and helped 95,000 members apply for SNAP, and we also estimate that this type of simple SMS campaign has put over $34 million in our members’ pockets. and nearly $50 million in the local economies,” she said.
Additionally, individuals “appreciate being asked if they have a need,” Moore said. “As soon as they are asked, there is almost this wave of appreciation that we see this as an aspect of health and that we would be so caring that we would ask about aspects of their life at home” , such as food and housing. “The hardest part for us was really getting our caregivers to feel comfortable asking the question. This required training and coaching to help people know how to ask these questions. »
Intermountain uses a technology platform called Unite Us that allows caregivers to connect a patient to social services, whether food or related to other needs. “I think that’s the future,” Moore said. “We are all doing our part in running a network of skilled nursing facilities, therapists, hospitals and clinics to help support our many patients. This is the start of a social network that will be a very important part of health management in the future.
Health systems are also finding creative ways to use their space to strengthen their missions. In Nemours, which has two children’s hospitals and facilities in Delaware, New Jersey, Pennsylvania and Florida, “one of the programs we have in place is our Can Grow Garden, which is actually a program on our campus designed to help empower more families “doing the same at home.” The program includes raised beds outside the cafeteria that serve as a demonstration garden to show families how to grow their own “I remember meeting a young woman who said to me, ‘I never knew what kale was. I didn’t know kale tasted so good,'” said Walker,” and I think that’s just the power of learning by experiencing life as you see it grow with your own hands and your own watering.
Harris then told a story that viscerally captured what living with hunger can be for children. At a neighborhood health center, the waiting room was disrupted one day when a young boy chased another child. The on-site doctor later learned the reason, Harris noted. The boy “hoped that [other] child dropped some Doritos from the bag he was carrying, because this young boy had not eaten for two or three days. That’s when you really start to think about how you feel,” and that ignites “that passion to do something.”
This incident sparked the creation of Eskenazi’s Crooked Creek Food Pantry, a full-service nonprofit facility located in the health center. Private providers can screen individuals and offer a “food-as-medicine prescription” for the pantry that has the items they need, Harris said. “It offers a significant advantage in terms of convenience [and] reducing [the] the stigma of having to go elsewhere for food.
Panelists said research efforts to assess the value of these initiatives are underway. These include well-designed studies to examine factors such as duration of meal delivery, number of meals provided per day, and disease categories affected.
Money is, as always, a challenge. “Obviously it takes large-scale funding” 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 launched during the pandemic. “Unfortunately, we don’t know how long this benefit will continue, and one of the potential sustainability challenges will just be adapting to a decrease in this support,” she said. “The harsh truth is that we’ve all struggled to fund these programs, and long-term sustainability will depend on the payers’ or society’s willingness to pay.”