As anchor institutions, hospitals are increasingly recognizing their “anchor mission” to harness their significant economic and other resources to address social and environmental determinants of health in the communities they serve. In the United States, an estimated 85% of health care costs are associated with treatment and management of diet-related conditions, and more than 10% of households are food insecure.
Our guidance helps health care professionals better understand key issues in our food system and take action. Resources include guidance for collaborating across hospital departments and with community partners to develop and increase the reach and impact of healthy food access and food is medicine interventions.
Healthy food program types
Healthy food access: Through investments in programming and purchasing, hospitals are creating healthy food access for patients, staff, and visitors and simultaneously building healthy, sustainable, and equitable food systems for their communities using tactics such as farmers markets, community supported agriculture (CSA) programs, and more.
Food is medicine: A “food is medicine” approach considers how food and nutrition play a role in diagnosis, treatment, and prevention of disease and have been found to influence health care costs, utilization, and health outcomes. For centuries, diverse cultures and communities have recognized food as an integral component of health and well-being. Food is medicine approaches today bridge clinical care and community food and nutrition programs and include medically tailored meals, medically tailored groceries, and produce prescription programs.
Below are a few validated strategies to assist hospitals in nourishing their communities
Understand the needs of your community
Conduct patient food insecurity or health screenings to identify hunger as a health need.
- Develop an accessible and reliable database of social resources and connect patients to these resources.
- Implement an active referral system.
- Provide patients with supportive services, such as patient navigators.
- Reduce or remove language and cultural barriers.
- Connect patients with resources that address social determinants of health that are interconnected with food insecurity, such as housing and transportation.
- Ensure that screening results are shared publicly (anonymously and in aggregate) and used to inform strategies to address food security.
Assess and address staff food insecurity.
- Survey staff about food security.
- Develop and implement a program or protocol for referring food insecure individuals to community-based resources.
Consider your hospital’s role in supporting community food needs.
Massachusetts General Hospital
Staff at Massachusetts General Hospital (MGH)’s Revere and Chelsea primary care clinics screen all patients for food insecurity. In 2015, 1,830 patients were screened for food insecurity in pediatrics, adult medicine, and prenatal at MGH Chelsea.
For nonprofit hospitals, conduct community health needs assessments (CHNAs).
- Use data sources to assess food access, environments, and behaviors in CHNAs.
- Engage the community to understand food needs.
- Engage food policy councils or other advocacy organizations in community health needs assessments and improvement strategies.
- Integrate valuable climate co-benefits of new or existing food-related initiatives into your community benefit implementation strategy.
- Consider community health risks of industrial agriculture as part of your community health needs assessment process.
- Make the case to leadership for community benefit programs that address food insecurity and healthy food access.
Arkansas Children’s Hospital
Staff at Arkansas Children’s Hospital implemented a pilot program to screen for social determinants of health at a clinic. In 2016, 7,048 individuals were screened, and 2,074 were identified as food insecure.
Support food access programs that directly expand access to healthy food for low-income residents and/or people of color, with the goal of increasing food security.
Identify community assets that contribute to healthy food access.
Get involved in healthy food initiatives in your community.
- Ensure that the community health needs assessment includes data on food insecurity and food environments, and include at least one food advocacy organization in the process.
- Actively support or sponsor initiatives that directly expand access to healthy, culturally relevant food for low-income residents and/or people of color.
- Support student health and community food systems through farm-to-school programs through financial investments, staff time, or in-kind support. Provide community benefit support to enhance the reach and impact of school meal programs.
- Participate in summer, after-school, and weekend meal programs.
- Support off-site hospital farms, farm stands, and/or food-producing gardens through financial investments, staff time, or equipment and materials donations.
Gundersen Health System and Mayo Clinic Health System – Franciscan Healthcare
Gundersen Health System and Mayo Clinic Health System entered into a formal agreement with Get Active LaCrosse to support the Coulee Region Farm2School program by contributing funding to support technical assistance for schools. The partnership is enabling LaCrosse County to continue farm to school activities in 19 schools. Gundersen and Mayo Clinic are also members of the Fifth Season Cooperative, which supplies local food to multiple institutions and supports increased student access to local foods.
Build critical partnerships that support access to healthy food.
- Partner with food banks and food pantries to increase access to healthy food.
- Partner with public health departments and local agencies to increase access to and promote healthy food options in corner stores and other retail settings. Hospitals can support these efforts by providing funding, training, and resources to help store owners stock and promote healthy food choices.
- Work with community partners to identify funding sources to support collaborative and sustainable financing of healthy food access initiatives.
Lehigh Valley Health Network
Lehigh Valley Health Network (LVHN) provides financial support or staff time to coordinate fruit and vegetable incentives that can be redeemed in corner stores in low-income or food desert communities. LVHN staff coordinate the Heart Smarts screening program as part of a Healthy Corner Store Initiative, funded by a block grant to the Pennsylvania Department of Health. Consumers who participate in health screenings and cooking demonstrations receive “heart bucks,” which can be redeemed at the store for healthy items.
Include values-based purchasing in these food initiatives to expand their impact.
Engage community partners and stakeholders in evaluating healthy food access interventions.
Develop interventions to promote healthy food access and healthy eating for patients, staff, and community.
Offer healthy food access programs at your facility.
- Establish on-site farmers markets or farm stands and ensure these outlets accept Supplemental Nutrition Assistance Program (SNAP) benefits.
- Offer community supported agriculture (CSA) food box program for patients, employees, and/or community.
“When our 11-year-old daughter was diagnosed with cancer, as an undocumented family our [food] resources were very limited. We are so grateful for La Cosecha because it was how we started as a family to find solutions for what we could do with our limited resources in battling this serious illness.”
— La Cosecha patron
- Set up an on-site hospital farm, farm stand, and/or food-producing garden.
Increase staff and community wellness opportunities
- Develop and implement an employee wellness program that includes health and nutrition education (avoiding diet culture biases).
- Ensure that food service patrons (including staff) have access to healthy and culturally relevant meals with adequate time to eat during their shifts or meal times.
- Offer healthy meal incentives at your facility.
- Accept Supplemental Nutrition Assistance Program (SNAP) or other incentive redemption options at your facility.
- Share food access resources, webinars, and events widely. Some hospitals use cafeteria spaces (table tents, TVs, signage) to share resources. Consider including post-hospitalization food access resources on patient trays and with discharge papers.
- Implement community health and nutrition education programming. You might consider an interactive/educational garden program on-site if your facility has a food-producing garden or farm. You can also coordinate off-site farm visits to engage hospital staff and the community and connect them to regional food producers.
- Engage community members via public relations events. Health fairs, tabling, sponsorship, and co-branded events can help the institution share its values with the community and connect with community members to better understand their needs. Speak with the institution’s public relations team about creating these opportunities.
- Provide staff time and expertise to carry out healthy food access program components.
Harborview Medical Center
Dieticians at Harborview Medical Center offer group and one-on-one healthy cooking classes for participants in the Fresh Bucks program. Behavior change surveys found that 89% of participants reported that Fresh Bucks made a difference in their families’ diets in 2016.
- Take a lead role in managing a fruit and vegetable prescription program or partner with another organization or coalition that is managing the program.
“With eight people in our family, I’ve had to really watch what I spend money on, so I do a lot of coupon clipping. But you don’t find coupons for fruits and vegetables – the Veggie Rx program has been absolutely great because it helps me to actually afford the healthy food that I want to feed all my kids.”
– Bethany Thompson, Veggie Rx client
- Provide grant support for fruit and vegetable incentive programs.
- Offer medically tailored meal programs, groceries, and food pharmacies at your facility.
- Support policy/advocacy efforts to make healthy food a covered benefit for Medicare/Medicaid patients.
Kaiser Foundation Hospital
Kaiser Foundation Hospital in Los Angeles awarded a community benefit grant for a nutrition education intervention program tailored to Latino youth located at a community garden. A 2010 pilot study found decreases in body mass index and diastolic blood pressure for program participants when compared to a control group.
Include values-based purchasing in these food initiatives to expand their impact.