Category Archives: Stories

Front Page, Stories

by National Council of La Raza

Healthy food choices are much easier to make in a supportive food environment — where healthier foods, such as fresh fruits and vegetables and foods that are less processed, are available and affordable. Too many Hispanic families do not live in a supportive food environment. Counties with large Hispanic populations have a greater proportion of people with limited access to grocery stores (29 percent) than other counties do (21 percent). Latino children and low-income people are at particular risk.

In a national survey, more than 10 percent of Hispanics reported difficulty in accessing affordable fresh fruits and vegetables— a higher rate than any other racial/ethnic group. The survey also found that access to fresh produce is linked with better health: people who reported that they were in poor health were four times as likely to face access barriers as people who said they were in excellent health (20 percent vs. 5 percent).

Research shows that larger chain supermarkets tend to carry more healthy food items, such as produce, at lower prices, while smaller convenience stores tend to carry less fresh produce and more snack foods that are calorie-rich but nutrient-poor. Thus, neighborhood convenience stores typically cannot compensate for the lack of a supermarket that offers healthy foods.

Hispanic neighborhoods, particularly those in nonurban areas, have almost one-third fewer chain supermarkets but more convenience stores than non-Hispanic neighborhoods. Better access to chain supermarkets has been associated with lower adolescent body-mass index (BMI) scores and lower rates of overweight. Greater access to convenience stores, in contrast, has been associated with higher BMI and frequency of overweight. Latino children have high rates of overweight and obesity and are consequently more likely to develop largely preventable diseases such as diabetes. All signs indicate that any discussion of public health should include a look at the local food environment.

The National Council of La Raza — the largest national Hispanic civil rights and advocacy organization in the United States — works to improve opportunities for Hispanic Americans. Learn more at www.nclr.org.

Front Page, Stories

Columbia St. Mary’s Hospital in Milwaukee is a member of Ascension Health, the nation’s largest nonprofit health system and its largest Catholic health system. Ascension’s call to action is “to provide health care that leaves no one behind.” Milwaukee is one of the poorest cities in the nation. With poverty rates higher than 40 percent in parts of the city, many of Milwaukee’s neighborhoods have been left behind.

Columbia St. Mary’s sponsors a community-based, chronic disease management program (CCDM) located at food pantries operated by churches around the city. Because disease management is so heavily influenced by dietary choices, it made sense to locate the program in food pantries so that it is easy to incorporate nutrition counseling into the health screenings. “The cyclical in control/out of control management of chronic diseases cried out for a model of care different from the office-based, doctor-centric approach,” says Bill Solberg, Director of Community Services at Columbia St Mary’s.

The program employs two parish nurses who work with churches in some of the city’s most disadvantaged African American and Hispanic communities. A parish nurse is a registered nurse who works within a faith community to respond to the health issues of the members and the broader community or neighborhood. What distinguishes a parish nurse is the spiritual side of her work. “We’re not just our heart or our liver or our kidneys,” says Maureen Daniels of the International Parish Nurse Resource Center. “Part of being a person is that whole dimension of spirit that makes us who we are.”

Columbia St. Mary’s is a Catholic institution, but parish nursing is not a distinctly Catholic vocation — many prefer the term faith-community nurse. There are approximately 15,000 parish/faith-community nurses in the United States, and it is one of the fastest growing specialty practices recognized by the American Nurses Association.

Julia Means, one of the nurses employed by the hospital, is a member of Ebenezer Church of God in Christ, the site of one of the pantries. Solid partnerships with the churches have been the key to ensuring that the program is sustainable. Charles McClelland, Bishop of the Northwest Wisconsin Jurisdiction of the Church of God in Christ (COGIC), was so impressed with the CCDM program that he invited Means to coordinate the health ministries of all 42 churches that report to him.

The pantries stock the healthiest foods they can get. Healthy items such as chicken breasts, fresh fruit, and vegetables can be purchased from the Feeding America network food bank for a modest fee per pound, which allows the food bank to cover its maintenance costs for transportation and storage. Solberg estimates it costs Columbia St. Mary’s about $1,500 per year to support one pantry. That is less than the cost of one overnight hospital stay.

Stories

Community Servings provides medically tailored, home-delivered meals to people with acute life-threatening illnesses. Medically tailored meals are at the very top level of food assistance. While less specialized efforts such as the national nutrition programs and emergency food assistance are determined to provide the most nutritious foods they can, the quality of medically tailored meals can be a matter of life and death. Community Servings and other organizations that provide meals tailored to their clients’ medical conditions could be considered a nexus between nutrition programs and health care.

Medically tailored meals are carefully constructed by dieticians and created by specially trained chefs, whose challenge is not only to meet the specific dietary guidelines required for each disease or condition, but also to make the meals tasty. This is vital since a common side effect of the medications that people with life-threatening illnesses are taking is loss of appetite. Chefs also do their best to take into account the unique characteristics of their clients/patients, such as cultural backgrounds, using comforting flavors to remind them of pleasant times spent with family and friends, when none of these may now be within reach.

Community Servings operates a state-of-the-art nutrition facility in Jamaica Plain, a neighborhood outside Boston, producing and delivering 9,600 lunches and dinners per week to individuals and families across 300 square miles in Massachusetts. Clients are enrolled through physician referral. More than 90 percent are living in poverty. All are critically ill, too weak to leave their homes or stand at the stove to cook. Without these meals, they could literally starve to death in their homes.

Community Servings was founded in 1990 while the HIV/AIDS pandemic was raging in the United States. The first generation of antiretroviral drugs had recently arrived, but they were less effective than the ones available today, and they required strict compliance with complicated medication protocols. And, as it turned out, lack of proper nutrition and food insecurity posed a major barrier to metabolizing them. Community Servings was launched by AIDS activists, faith groups, and community organizations to deliver dinners to patients who were too weak to shop or cook for themselves. Other organizations soon formed to do the same. All got a boost when the Ryan White CARE Act was passed in 1990 since it set aside funds for home delivery of medically tailored meals.

Now, more than 25 years after it started, Community Servings has expanded its operations to provide 25 different meal regimens based on clients’ medical conditions. The largest share of meals still goes to people with HIV/ AIDS, followed by meals for people with cancer, renal failure, diabetes, cardio and lung diseases, and multiple sclerosis.

“In the continuing debate about how to control soaring healthcare costs, poor nutrition and lack of access to healthy food are routinely ignored,” write David Waters, CEO of Community Servings, and Robert Greenwald, director of the Center for Health Law and Policy Innovation at Harvard Law School. Public and private insurers spend millions of dollars on health care for critically ill patients, but if the patients do not have the right food, there is much less chance of a lasting recovery.

Today the demand for medically tailored meals far outstrips the supply of service providers. Community Servings is one of fewer than a dozen nonprofit organizations across the country that are able to deliver complex, medically tailored meals to critically ill patients. Nursing homes and hospitals can and do provide such meals, but organizations like Community Servings can produce and deliver them at a fraction of the cost. Yet nursing homes, hospital stays, and prescriptions are covered by insurance, while medically tailored meals are not.

As part of healthcare reform, state Medicaid programs could seek permission to experiment with medically tailored meals. As noted above, the vast majority of Community Servings’ clients are income-eligible for Medicaid. The cost savings alone should be enough to grab policymakers’ attention. Researchers found that the monthly healthcare spending on patients who were receiving medically tailored meals was 37 percent lower than the expenditures for those with comparable conditions who were not receiving these kinds of meals. Studies also show that patients receiving medically tailored meals adhere more closely to their medication regimens, miss fewer medical appointments, and are readmitted to the hospital at lower rates. Ninety-six percent of the healthcare workers surveyed by Community Servings reported that the home-delivered meals improved patients’ health.

Stories

Macon County, Alabama, is located within the rural southern Black Belt, a region of the country that suffers disproportionately from persistent poverty, poor health, structural racism, and chronic food insecurity.

In 2015, the Robert Wood Johnson Foundation released county health rankings for every state in the country. Of the 67 counties in Alabama, Macon was ranked third from the bottom on a Food Environment Index, based on the food insecurity rate (26 percent) and the share of the population with limited access to healthy foods (19 percent).

The Black Belt is predominantly African American, the main reason for its name. The Black Belt is also a reference to the original places of black slavery from Africa. At one time it was also named for the rich, dark soil, and the black workers who cared for the land and made it possible for Alabama to have a profitable agricultural sector. The soil is still there and so are the descendants of that time, but many have left the rural areas for the urban way of life thereby leaving the land behind. This has had consequences for the people and the land.

“It was amazing to me how much we had gotten away from that history,” says Rev. Otis Head, pastor of Mount Calvary Missionary Christian Church in Macon County. “All this land and good soil that we have and aren’t doing anything with. Our community has food, but so little of it is healthy.” Rev. Head moved to Macon County in 2006. His parents had attended Tuskegee University in Macon County, and as a child he visited here many times, remembering the pride his parents’ generation had in its agricultural legacy.

The agricultural department at Tuskegee was headed originally by none other than George Washington Carver, who was offered the position by its founder and first president, Booker T. Washington. Carver was already famous for his contributions to agricultural science, and Washington wanted Carver because agriculture was central to his philosophy of black self-sufficiency.

Founded in 1881, Tuskegee is one of the country’s first Historically Black Colleges and Universities (HBCUs). HBCUs have their roots in the black church, and the close association continues to this day. Rev. Head and others on the Macon County Ministers Council reached out to the agricultural department at the university, asking for help in using available land to improve the local food system. They started with community gardens on church properties. The foods grown there are distributed through a pantry run by the council, and they are available to the entire community. “It has made a difference,” says Rev. Head. “People tell me they feel better, and I can see it myself.”

The black church is the key stakeholder when it comes to matters of community health and building trust and bridges between the African American community and the health profession, particularly in rural communities. It is not uncommon, for example, for clergy in Macon County to take calls from families asking for help because they have run out of food. When someone in the family is sick, it may require a minister to persuade the person to see a doctor given the history of racial discrimination in health care which, in great part, explains why some African American communities are wary of doctors. This kind of leadership by African American churches can help the community to overcome the history of racial discrimination in health care.

“The past isn’t dead and buried. In fact, it isn’t even past,” said candidate Barack Obama, in a 2008 speech about race relations.69 The ACA, better known as Obamacare, will have only limited success in places like Macon County without support from the church leaders. The church will lead the community building as it always has, because the church has the trust of local residents that other structures often do not. This may be true in other parts of the country as well, but it is especially true in the rural Black Belt.

Front Page, Stories

by Molly Marsh, Partners In Health

Store manager Cheryl Blair ushers a small group of employees and health workers into her second-floor office, which overlooks the shelves of Totsoh Trading Post near Tsaile, Arizona, in the Navajo Nation.

They settle themselves into chairs, ready to hammer out the mechanics of a program that aims to improve Navajos’ health by increasing their access to fruits and vegetables. Called the Fruit and Vegetable Prescription Program (FVRx®), the effort links retailers, community health workers, and clinics to create a better supply of and demand for fresh produce.

“Notice our food — it’s all junk food,” says Blair, gesturing toward aisles of chips and beef jerky, soda, and sugary confections. Not many kids are introduced to fresh foods at a young age, she continues. “It’s hard — if you can’t eat it as a kid, you’re not eating it now.”

There are only about 100 stores like this in Navajo Nation, an expanse of 27,425 square miles stretched across parts of Arizona, Utah, and New Mexico, and most carry little fresh produce. In fact, the U.S. Department of Agriculture has classified the entire territory as a food desert. The grocery stores and convenience stores are hard to reach — or out of reach — for Navajo who lack regular access to transportation, and high poverty rates mean most people can’t afford to buy healthier foods even if they were available: 44 percent of households live below the poverty line. With dollars to stretch, families opt instead for dense, calorierich food that fills them up.

The corresponding effect on health is alarming. Navajos experience high rates of obesity and malnutrition, as well as diet-related illnesses such as diabetes and hypertension. Heart disease and diabetes are the leading causes of death on the reservation; about 26,000 people — nearly 22 percent of the adult population—have diabetes. Half of all children are overweight or obese.

Community Outreach & Patient Empowerment (COPE), a Gallup, New Mexico-based project of global health nonprofit Partners In Health, helps tackle these health disparities by providing training and support to nearly 100 community health representatives (CHRs) employed by Indian Health Services.

These CHRs play a critical role in communities. They visit people in their homes — many of whom they’ve known for years — to provide health care, and connect them to clinics and hospitals when they need more specialized treatment. They also counsel clients on healthy living habits, including eating more nutritious foods. Without reliable access to those foods and extra money to buy them, however, clients struggle to change their diets.

In response, COPE has become a catalyst and partner in a movement under way across the reservation to create stronger links between food and health. Scores of local and tribal health facilities, community organizations, and food security activists are pushing to create more awareness among Navajo about the importance of eating nutritious foods. These groups are also working to revitalize Navajo food traditions, promote food sovereignty, and spur economic development.

FVRx® is one part of this effort. Developed by food access organization Wholesome Wave, the program in Navajo Nation targets new and expecting mothers with gestational diabetes, and overweight or obese children from 3 to 6 years old. CHRs work with local health providers to identify families with these health risks and enroll them in the program. Clinicians also encourage their patients who meet these criteria to participate.

When an expectant mother visits her doctor at Tsaile Health Center, for example, she is referred to a CHR who talks with her about nutrition and is given a “prescription” worth $1/day/per family member that she can redeem for fruits and vegetables at Totsoh Trading Post. The voucher is good for one month.

This mother will receive a check-up from her doctor once a month for six months, at which her weight and blood pressure are measured, as well as other vitals. If she has a young child who is overweight or obese, that child will also receive regular monitoring. Over their period of enrollment, COPE staff will collect data on their Body Mass Index measurements and fruit and vegetable consumption to check their progress.

“We’re working on the basic concept that food is medicine,” says Memarie Tsosie, COPE’s food access manager. “Back in the old days, most of our grandparents ate food to nourish their bodies. Now it seems like food is for convenience. We want to bring back the notion that families can use healthy food to create healthy lifestyles.”

So far, about 100 families from the territory’s southeast region are participating in FVRx®, as are 10 health centers, two grocery stores, four trading posts, six convenience stores, and one farmers market. More of each will join the mix in subsequent months. COPE’s goal over three years is to expand into every region of Navajo Nation, reaching 75 percent of its population — about 135,000 people.

To ensure fruits and vegetables are available for them, COPE’s FVRx® team has identified all retailers on the reservation, recruited stores to participate in the program — Totsoh is one of the first — and helped owners better promote the purchase of fruits and vegetables in their stores. The team also works with farmers markets and local growers to try and get their produce on to store shelves. The idea is to encourage stores to increase the number of healthy offerings while guaranteeing a certain level of demand for owners and growers.

FVRx® teams also coach retailers through the voucher redemption process, which is the reason for the gathering in Blair’s office. The women work through possible snags — how to make sure IDs are accurate, what to do if shoppers forget their vouchers or if they buy more than they have credit for. The dietician among them also helps plan a menu for a cooking demonstration the store would like to hold. They settle on spinach smoothies, and chicken salad with pecans and cranberries.

While FVRx® enrolls specific families, the program’s underlying goal is to create an environment where entire communities have access to affordable fruits and vegetables. And it’s working — Blair and other store managers say they’ve seen an increase in the amount of produce purchased by families who aren’t participating in FVRx®. They initially worried they wouldn’t be able to sell everything; now they’re selling out.

Molly Marsh is Managing Editor of Partners In Health, a global nonprofit that provides health care to poor communities in 10 countries. Read more at www.pih.org.

Stories

“We’re saying let’s get healthy together,” explains Darren McCormick, the mayor of Williamson, the largest town in Mingo County, West Virginia, and the epicenter of an outstanding effort to transform the self-image of a community — from poor health and persistent poverty to good health and a sustainable future.

Mingo County is located in the heart of Central Appalachian coal country. At first blush, it would seem to be the most unlikely of places to be described by the word “sustainable.” Mingo County is one of the poorest, unhealthiest counties in West Virginia. The early death rate is one of the highest in the nation. Almost 40 percent of adults are obese, and the child obesity rate is not much better. One in three of fifth graders have been diagnosed with high blood pressure.

Fifty years ago, Mingo County, by virtue of its location in Central Appalachia, was one of the proving grounds in the War on Poverty. Politicians from Washington, DC, came to the region and said, “We’re going to end poverty in Appalachia.” But poverty wasn’t ended here, and many people who live in the region feel they’ve been stigmatized as losers ever since.

It’s a mindset that McCormick says he shares. And yet he’s thankful for the support provided by federal programs such as SNAP and WIC. In the early 1960s, there was rampant hunger and severe malnutrition in the region, and the social programs created to address those hardships did erase them for the most part. But what the War on Poverty failed to do was to help diversify the economy to be less dependent on coal.

Geologists predict that it will be only another two to three decades before the county’s coal reserves run out. Nearby McDowell County has already been totally mined out. Thus, sustainability is more than leaders recognize that if the place is not only going to survive, but also thrive, residents have to transform the way they see themselves. So the town’s message is designed to give people hope. “Our mission statement isn’t individual projects anymore,” McCormick said. “Our project is creating a more sustainable way of life.” If it sounds like a long shot to some outsiders, you won’t find many people in town without hope.

One priority is stemming the diabetes epidemic. “Health, quality of life, and economic development issues are inseparable,” says Dr. Christopher D. Beckett, who grew up in Williamson and goes by Dino to people around town. Mingo County is located in what is sometimes called the nation’s diabetes belt: 644 counties spanning 15 states. For the country to make progress against the rising costs of health care, it will have to develop innovative approaches to managing diabetes. In 2011, the Mingo County Diabetes Coalition was established with support from a federal grant to pilot such approaches and ultimately help reduce the cost of diabetes to the Medicaid and Medicare programs. The Centers for Disease Control and Prevention reports that if current trends continue, as many as 1 in 3 U.S. adults could have diabetes by 2030. Places like Mingo County are today’s proving ground to try to reverse those trends.

Beckett leads the Diabetes Coalition, which has patients participating in a comprehensive program that includes exercise, eating well, and proper use of medication. Patients who’ve gone through the program have experienced a drop in A1c hemoglobin levels by an average of 2.1 percent. A1c is associated with blood glucose levels; it is a critical indicator in managing a diabetic patient’s condition. A 2.1 percent drop is huge, explains Beckett. “If you were a drug manufacturer and you were able to drop [A1c levels] by just 0.6 percent, you would have a billion-dollar drug.” A 2.1 percent improvement translates into a 29 percent reduction in the risk of a heart attack, a 50 percent reduction in renal failure and need for dialysis, and a 90 percent reduction in the likelihood of amputation. The program’s success explains why more people around town are starting to wear pedometers and mid-day walks have become popular among townsfolk of all ages.

Beckett has gotten patients to eat healthier by prescribing (literally writing prescriptions for) a diet high in fruits and vegetables. The Mingo County Diabetes Coalition provides patients with vouchers to purchase the food. Much of that shopping is done at the Williamson farmers market since the town is a classic example of a rural food desert. The closest full service grocery store is more than 30 miles away. The farmers market, started in 2012, was designed not only to improve access to healthy foods but also to be part of an economic development strategy. During the planning phase, McCormack approached the USDA Extension office at West Virginia University in Charleston, a hundred miles north, and asked how many people in Mingo County were farming. “USDA told us nobody was farming here — because nobody had gone to the extension office for help. Well, anybody who lives here knows that wasn’t true.” McCormack dispatched a VISTA volunteer to go back into the hollows and survey how many people were growing food. The survey found that there were many more “farmers” than anyone had realized. The farmers market now provides a source of income for these local growers.

Healthy food is central to promoting the message of a sustainable future. Because of the market, and the new community gardens that have also been created, students at the middle school in Williamson — 80 percent of them on free or reduced price meals — have asked their principal to create an agriculture program at the school. An orchard has been built on an abandoned strip mine. A small-business incubator program is helping a local entrepreneur open a restaurant that will provide the first genuinely healthy menu in town. “If you had asked people where to go to eat, the only places they might know are McDonald’s and Wendy’s,” says Beckett.

“It’s one of the best grassroots efforts I have ever seen,” said Tracey Rowan, area director of the U.S. Department of Agriculture. “At their meetings, the excitement is contagious. I’ve never seen anything like it. It’s likely to succeed and likely to last, in great part because these people are committed to living and working there.”

Sustainable Williamson has captured the imagination of people in the community, and it has also captured the attention of people outside the community. In 2014, Williamson was one of six communities around the country to receive the Robert Wood Johnson Foundation Culture of Health Prize for Innovative Efforts to Improve Health. “It is tempting to look at this area and think about everything that’s wrong with it and get discouraged,” says Beckett. “But there is also a different way of looking at it. Seeing these problems as opportunities.”