Ensuring Access To Good Food Improves Health Of Poor Chronically Ill Milwaukee Journal Sentinel
Ensuring Access To Good Food Improves Health Of Poor, Chronically Ill – Milwaukee Journal Sentinel https://clarkcountynewsnow.com/ensuring-access-to-good-food-improves-health-of-poor-chronically-ill-milwaukee-journal-sentinel/
Shelly Greer, diagnosed with diabetes in late 2017 at the age of 38, was struggling to manage the disease when a physician referred her to a new program at Ascension Wisconsin.
“I really needed it at the time,” Greer said.
Her HbA1c, a blood sugar measurement critical for diabetics, was at 10; below 8 is the threshold for diabetes under control.
Ascension Wisconsin started the program — called Under 8 — in 2020, focusing on patients who live in the low-income neighborhoods near its Ascension SE Wisconsin-St. Joseph campus on the city’s northside.
The 12-week program provides five prepared healthy meals — designed for people with diabetes — each week from UpStart Kitchen, a restaurant incubator in Milwaukee’s Sherman Park neighborhood. The program also provides grocery bags of food healthy for diabetics, and holds weekly meetings that offer counselling on nutrition, lifestyle and medication adherence.
Over the duration of the program, Greer’s HbA1c fell from 10 to 6.3.
The program is an example of how to improve health by going outside the four walls of a clinic and meeting people where they live, said Nancy Leahy, a nurse practitioner with Ascension Wisconsin.
“We do it in a community setting, where people are a little more comfortable than meeting in a hospital or a clinic,” she said.
It also is one of hundreds of initiatives — most of them small for now — started by health systems nationwide that move beyond doctor visits in clinical settings and instead address underlying social and economic conditions that affect health, particularly among poor people.
Those conditions — what are known as the social determinants, or drivers, of health — can be more important than access to the best doctors and medicines in influencing a person’s overall health. They include food, housing, education, employment, neighborhoods, and the support of family and friends.
Putting more resources toward addressing them not only could improve lives, it could save money.
Adequate and stable housing often is considered the foundation of good health. But access to healthy and appropriate food can be as important, particularly in managing chronic conditions, such as diabetes and heart failure. And those conditions are more common among people who have low incomes.
Some initiatives by health systems and, increasingly, health insurers focus on finding new ways to help people with those conditions to eat healthier. Some center on lessening food insecurity — the uncertain access to adequate, quality food. Some do both.
There are hurdles to overcome.
Healthy food can be more expensive, and the amount of money someone on a tight budget spends on housing can limit what’s left for food.
Seth Berkowitz, a physician and professor of general medicine and clinical epidemiology at the University of North Carolina at Chapel Hill
Fundamentally this gets down to insufficient resources that people need to maintain health, and food insecurity is just one manifestation of that.
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Lower-income neighborhoods may be so-called food deserts, where corner convenience stores with limited offerings have taken the place of full-fledged supermarkets. For someone without a car, a trip to a supermarket can become a trek that involves several buses, possibly young children in tow, and then hauling back bags of groceries.
“Fundamentally this gets down to insufficient resources that people need to maintain health, and food insecurity is just one manifestation of that,” said Seth Berkowitz, a physician and professor of general medicine and clinical epidemiology at the University of North Carolina at Chapel Hill.
Education and health literacy — understanding what makes up a healthy diet and how to achieve it — also have a role. People who are skeptical of the prevalence of food insecurity note that many poor people are overweight or obese. What’s lost is that some, without the knowledge or the ability to get good food, may be getting by on calorie-rich processed foods and snacks.
The impact of food insecurity on health is not new.
For adults, it is associated with diabetes, heart disease, high blood pressure, obesity, chronic kidney disease, osteoporosis, depression and other medical conditions, according to the Food Research & Action Center.
Food insecurity added an estimated $51.8 billion a year to the health care costs for adults, according to a 2019 study done by Berkowitz and his co-authors.
That included an estimated $687 million in additional health care costs in Wisconsin.
The study found that health care costs for adults who were food insecure was $1,073 to $2,595 a year higher than costs for adults who had adequate food.
The study did not find a significant increase in costs for children.
But food insecurity is associated with an array of poor health outcomes for children, from more frequent colds and stomach aches to behavioral health conditions, according to the Food Research & Action Center.
Rowan Van Patten, 19, from Davenport, Iowa, a Milwaukee Institute of Art & Design student, with food received from the Interchange Food Pantry. Van Patten doesn’t receive assistance from family, and struggles to balance the cost of school and meals. He sought assistance at food pantries. Angela Peterson / Milwaukee Journal Sentinel
“After multiple risk factors are considered, children who live in households that are food insecure, even at the lowest levels, are likely to be sick more often, recover from illness more slowly, and be hospitalized more frequently,” the American Academy of Pediatrics said in a policy statement titled Promoting Food Security for All Children. “Lack of adequate, healthy food can impair a child’s ability to concentrate and perform well in school and is linked to higher levels of behavioral and emotional problems from preschool through adolescence.”
For adults, much of the increased cost for adults came from more hospital stays and emergency department visits.
Here’s one example: A study done in California found a 27% increase in hospital admissions for people with diabetes who have low incomes in the last week of the month compared with the first week. There was no change for people with higher incomes.
The likely reason is that people with low incomes had exhausted their food benefits and had less access to the foods essential to managing the disease at the end of the month.
The increase overall actually was higher. The study looked at just hospital admissions and did not include increased visits to clinics or emergency departments.
Nationally, initiatives by health systems have included providing financial support, such as low-interest loans for supermarkets to open in a low-income neighborhood. Some are experimenting with providing medically tailored meals to people with chronic diseases.
The initiatives supplement and build on the work done for decades by organizations throughout the country, such as the Hunger Task Force in Milwaukee, to lessen food insecurity and encourage healthy diets.
Chorus Community Health Plans, formerly Children’s Community Health Plan, for example, has a pilot program — Fresh Food Rx — that enables physicians and other clinicians at its Midtown Clinic to give vouchers for Pete’s Fruit Market to people who have been screened for food insecurity.
Juan Gonzalez stocks fruits and vegetables at Pete’s Fruit Market in Milwaukee. Children’s Wisconsin has a pilot program at its Midtown Clinic, 5433 W. Fond Du Lac Ave., in which a physician, or other clinician, can give struggling patients vouchers for food at the grocery store. Angela Peterson / Milwaukee Journal Sentinel
The grocer offers items such as its popular value baskets that contain a mix of vegetables and fruits, said Sam Cunningham, manager of the store at 2323 N. Dr. Martin Luther King Jr. Drive.
“Healthy eating means a long-lasting life,” Cunningham said.
Again, there are hurdles.
Children can be picky eaters, said Lisa Zetley, a pediatrician at the Midtown Clinic. Families with low incomes often buy things that won’t spoil. Some people don’t know how to cook different vegetables.
Chorus Community Health Plans, an affiliate of Children’s Wisconsin, offers everyone in its health plans free access to the Foodsmart app.
More than 5,400 people in its health plans have signed up for the app. One feature provides access to a registered dietrician, and 3,145 people in the health plans have made use of that feature more than 5,500 times so far.
The app also provides healthy recipes that appeal to children. It then turns the recipes into a shopping list — and shows which supermarkets have the lowest prices for the ingredients.
The idea is to offer personalized, culturally relevant recipes that are affordable and support lasting changes to eating behavior, said Mark Rakowski, president of Chorus Community Health Plans
“This is literally the first solution that resonates with all of our providers as they look to support the patients and families that are food insecure, or who are looking for support to eat healthier,” he said.
An estimated 33.8 million people — living in more than one in 10 households — were food insecure in 2021, according the U.S. Department of Agriculture.
This means they reduced the quality or variety of what they ate because of lack of money or other resources at some point during the year. It doesn’t happen regularly. But it happened on average in seven months of the year.
These figures require some parsing.
They include 8.6 million adults — and 521,000 children — who live in 5.1 million households with very low food security.
This means that one or more people in the household — usually an adult — ate less or went without food at times during the year because...
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