Public health practitioners often note that the push to improve population health should begin “upstream” of where adverse outcomes necessitate socially and economically costly interventions such as hospitalization and continuing care. That means addressing the biological and social determinants of health and wellbeing, particularly in communities where health disparities exist. But the behavioral, environmental, social, and physiological factors that influence health form strong currents that challenge those striving to navigate upstream.
To answer that challenge, many communities have formed partnerships that leverage their collective strengths to build momentum counter to the current. They work together developing and implementing innovative approaches to health care that are preventative by design and focus on issues such as poverty, food insecurity, documentation status, education, and promoting healthy behaviors.
In Portland, a group of community stakeholders has banded together to provide healthy, affordable food and nutrition education to families burdened by diet-related illnesses and lacking access to fruits and vegetables. Their project is called Community Supported Agriculture (CSA) Partnerships for Health. Its core members include Zenger Farm, the Multnomah County Health Department, OHSU Family Medicine at Richmond Clinic, Village Gardens, and Portland State University.
Supported by Kaiser Permanente Northwest Community Benefit and the Knight Cancer Institute Community Partnership Program, CSA Partnerships for Health provides one hundred families coping with diet-related diseases and limited access to healthy foods weekly shares of fruits and vegetables from local farms at a subsidized rate of five dollars per share. The partnership also offers nutrition education and access to cooking workshops. Participants can use benefits from the Supplemental Nutrition Assistance Program (formerly called food stamps) for payment. And harvests are made available at local health clinics, including OHSU Family Medicine at Richmond Clinic and several Multnomah County Health Department health centers.
“This partnership serves families without a lot of resources,” said OHSU-PSU School of Public Health faculty member Betty Izumi, a registered dietitian, and interventionist whose research explores methods of addressing diet-related chronic diseases. “These are families that might be socially isolated, struggling with problems associated with poverty, and they’re managing chronic, diet-related illnesses. They’re also motivated to improve their health, to eat more fruits and vegetables, and to learn about nutrition, cooking, and healthy eating.”
“Izumi is taking the lead on an essential part of the partnership’s work,” said Mike Wenrick, executive director of Zenger Farm, “which is to evaluate the impact of access to healthy foods and food education on our participating families throughout three growing seasons. She’s collecting and analyzing data that we hope will demonstrate improved overall health and ultimately drive health care spending on local vegetables and fruits.”
As Mr. Wenrick noted, the social and economic impacts of an unhealthy diet and lack of access to nutritious foods are immense. The Center for Science in the Public Interest estimates diet contributes to nearly 680,000 deaths a year in the US at the cost of roughly $958 billion. Meanwhile, food insecurity has negative impacts on family stability, workforce reliability, and performance at school.
“Food insecurity is a huge driver of medical costs,” said Brian Frank, MD, a physician at OHSU’s Richmond Clinic and liaison to the CSA Partnerships for Health project. “And it costs us as a society. So access to healthy food makes sense as a preventative measure, just like exercise does. When people eat healthy foods, their overall health improves. And it’s not just that when they eat well, they feel better; a healthy diet has long-term implications that are passed from generation to generation.”
With the aid of Izumi, the CSA Partnerships for Health project aims to build a foundation of qualitative and quantitative evidence and community support to advance the argument that everyone should have access to healthy foods as a measure to prevent diet-related chronic illnesses, reduce morbidity, and lower the cost of health care. To achieve that aim, the partners hope to translate their findings into policy recommendations that support improving overall health by increasing access to fruits and vegetables for those with limited resources.
“When you compare the cost of providing families nutritious foods to the costs of treating illnesses like diabetes and heart disease, promoting and subsidizing healthy eating starts to look like an excellent idea,” Izumi said. “We hope our work can contribute to that end.”
Providing families dealing with diet-related chronic illnesses access to locally grown healthy foods and nutrition education as CSA Partnerships for Health does is a common-sense solution to a challenge that needs to be met if society is to move upstream of where adverse health outcomes adversely affect families and raise the cost of health care. It’s the kind of solution that emerges when community stakeholders come together and leverage their collective strengths to improve public health and act to promote positive changes that benefit all of society.