Achieving nutritional equity means providing all communities with opportunities to access and learn about healthy food, allowing nutritious meals to be seamlessly incorporated into our diets. Everyone deserves the right to make healthful eating decisions and providing people with that opportunity must be an obligation of every community in the country. Those without opportunities to make consistent healthy food choices require interventions the most.
Food insecurity, defined as, “a household-level economic and social condition of limited or uncertain access to adequate food,” impacted 27.5 million adults and 12.5 million children in 2017 alone. Rural Communities face an increased risk of experiencing food insecurity due to a lack of grocery stores, store distance, lack of access to transportation and high food prices, all barriers to meeting appropriate dietary needs. With evidence showing healthy diets may aid in reducing chronic diseases like hypertension, heart disease and type 2 diabetes, foods high in nutritional content must be viewed as medical necessities to achieving health equity, especially in rural communities.
Food As A Means To Manage Disease
Community Servings, a Root Cause Coalition Inaugural Partner, is an organization with a 30-year history of providing home-delivered meals for those with barriers to medically-appropriate healthy food due to critical illness. The regional program serves meals and provides nutrition counseling to thousands of people in Massachusetts. Community Servings aims to maintain the dignity of clients through culturally appropriate home-delivered meals, nutrition education and other programs. Meals prepared for clients are medically-tailored, meaning they meet nutritional and medical needs to improve health outcomes for chronic illnesses like HIV/AIDS, cancer, and diabetes, among others. Nutrition education classes teach clients about food choice and appropriate preparation techniques. Community Servings believes food can help improve clients’ well-being when they have the tools to take charge of their health.
How exactly does the organization ensure that food can serve as a medical intervention? Valerie Machinist, a registered dietitian and Manager of Nutrition Services at Community Servings says it can be done by ensuring healthy food consumption is understood as a tool to improve health, the same way medicine is. “Dietary intake can impact health over time,” Machinist says. “Eating foods that promote good health as often as possible is the best thing you can do for your well-being. However… those foods need to be accessible and affordable as well.”
Medically-tailored meals address the diagnosis of clients with a goal of ensuring the best health outcomes. At Community Servings, clients complete an application, typically signed off by a physician or case manager who refers them to the organization. After a nutritional assessment, a registered dietitian (RD) assigns a medically-appropriate diet to the client. Community Servings’ team of RDs works in collaboration with the agency’s executive chef to develop meals cooked from scratch, that are then prepared for home delivery. “When we create medically-tailored meals, we are looking at the nutrient profiles of the meals to ensure they are appropriate for a variety of different diseases,” Machinist said. Community Servings offers 15 medically-tailored diets, and clients may have a combination of up to three. Depending on the needs of the individual, foods may be high in certain nutrients and limited in others as needed. Creating culturally-appropriate meals with dignity also means ensuring that the meals are appetizing and enjoyable to aid in maintaining healthy eating habits. Clients receive five days’ worth of lunches, dinners and snack foods, plus a quart of milk, delivered once a week to their homes. After distribution, Community Servings follows up with each client every six months to evaluate progress.
In order to keep health sustainable and encourage healthy habits, Community Servings also offers nutrition education classes for the local community. These programs allow community members and clients to understand how and where to find and prepare healthier foods when they may not be receiving it from the agency. The focus is on, “food as a way to help manage their disease,” says Machinist. Clients are also given resources to acquire food as they transition from the meal program.
With accessibility and affordability of healthy food acting as barriers to a lifetime of health, communities and health systems must collaborate to get food to those who are unable to access it. “Whether that’s through SNAP benefits, food pantries, or mobile produce trucks, individuals can’t choose healthy foods if they can’t access them,” Machinist said.
Developing A Food Is Medicine Mentality
A study from Community Servings with support from the Robert Wood Johnson Foundation found that participation in a medically-tailored meal program was associated with fewer nursing home and hospital admissions, and overall less spending on medical services. There was also a correlation with less hospitalizations and emergency room visits.
Access to healthy food is a key social determinant of health that impacts equity in health outcomes. Patients should be screened by medical professionals for food insecurity and health care professionals must be trained in identifying risk factors. Prioritizing social determinants and creating environments where patients feel comfortable discussing societal factors that impact their health is crucial. With some of the biggest barriers to healthy food being cost and transportation, cross-sector collaboration among community-based organizations and health care providers may be the essential solution improving nutrition and health outcomes for vulnerable populations. Insurer reimbursements for programs offering medically-tailored meals would also provide funding to assist similar programs in operations.