The Boston Medical Center has a preventive food pantry, says a lovely article in Reasons to be Cheerful. It is a recognition, not only that nutritious food is a key part of good health, but that people need help to understand how to choose and prepare good food.
It is part of how we change systems practically - by recognizing that good nutrition is part of a much bigger picture and an ecosystem, and that if all the people and institutions involved work together to address how that big picture idea affects individuals, everyone benefits. And this means health systems save money, which should appeal to conservatives.
It reminds me of how many European (and recently, North American) hospitals work with local organic farmers to buy ingredients - which also helps grow the local economy. And one Toronto group worked with farmers to grow unusual vegetables and then, in food boxes people signed up for, told recipients how they could cook them - ensuring the farmers had a market.
It is something that has interested me since, in Yellowknife, I met a woman from a small Inuit community who was studying at Aurora College in Inuvik but was struggling to feed herself and her son while also paying for after-school child care. I learned that social assistance rates at that time used bulk food prices - but such bulk buying was an investment that many students couldn’t afford - and most learners couldn’t make the money stretch, especially if they were paying rent and child care costs.
There was a practical answer, it seemed to me. Bring a group of learners together to purchase healthy foods in bulk and then use the college’s kitchen to prepare meals to share among their families. One learner in Yellowknife set up such a program, with help from regional dietitian Jill Christensen. Jill later taught these skills to women in Rankin Inlet, where the womens’ centre had recognized that women needed to learn new skills in food shopping and cooking when their families moved from the land into communities. The need became more acute when home economics classes were cut from school curricula.
There are some who think that poor people should be grateful for food banks and just accept what is on offer. When I volunteered at the Mustard Seed’s food bank here in Victoria, I learned that some clients were very aware of what foods they needed to eat, and which to avoid, and would choose carefully from what was available. Food banks, however, are obviously not able to tailor their offerings to people with various health conditions, much as they might like to.
That was what inspired the creation of the preventive food pantry. Doctors recognized that ‘prescribing’ is about more than prescribing a pill; it is expanding peoples’ understanding of what health means, especially if they have low incomes or low nutritional knowledge.
In many countries, this kind of knowledge is held in Indigenous systems. People who live in harmony with nature are likely to turn to locally grown produce or to teas with medicinal properties when they don’t feel well. I learned in Serbia, two decades ago, that doctors often prescribe such teas along with pills.
The Boston pantry, which opened in 2001, was an early pioneer in incorporating access to nutritious food directly into the medical system. Initially expected to serve 500 people a month, it serves more than 6,200 today.
“It’s part of the normal care, like ‘I went to the pharmacy, I’m also going to go to the therapeutic pantry,’ or ‘I was able to get signed up for home-delivered meals that address my chronic disease,’” says Catherine D’Amato, president and CEO of the Greater Boston Food Bank, which works with the Preventive Food Pantry and other Massachusetts health institutions. “That’s where you get alignment of care.”
This means tailoring a grocery cart to what each patient needs, the article explains. “Someone with a renal condition won’t get foods high in potassium, like oranges or potatoes. If they’re diabetic, they’ll get whole-grain pasta and brown rice. And everyone leaves with vegetables, fruit and other fresh ingredients.”
But healthy produce, fresh meat and dairy products are more expensive for families trying to stretch their dollar. So providing knowledge, as well as healthy food, is part of the treatment process at Boston Medical Center. And that kind of constructive approach can help to reduce health care costs, as health systems and insurers have begun to realize.
Across the US in 2014, health care costs associated with hunger were more than $160 billion. In Massachusetts alone, that cost was $1.9 billion.
Boston Medical Center screens all patients for social determinants of health, including food insecurity, and anyone who is not getting enough to eat is eligible, says pantry manager Latchman Hiralall, who is a registered dietetic technician.
Patients’ referrals note their health conditions so Hiralall and pantry staff members can make sure clients get foods that meet their needs. “If someone is diabetic or hypertensive or has kidney failure, we need to know that,” says Hiralall.
The program emphasizes fresh ingredients. Half the items the pantry brings in are perishable, and some of the produce is grown at a farm on the hospital’s roof, which produces 5,000 to 6,000 pounds of vegetables each year, with 70% distributed through the pantry.
The program also works with the hospital’s teaching kitchen, where dietitian chefs lead classes on how to prepare healthy meals. Recently, the pantry supplied ingredients for classes during which Hispanic and Haitian families taught recipes to hospital dietitians. “We’re learning at the same time,” Hiralall told Reasons to be Cheerful, “because different cultures have different ways of cooking and different types of food that they eat.”
Having the pantry as part of the medical system removes much of the stigma people feel about going to a food bank. “They know that this is part of their care,” Hiralall says. “Their doctor gave them a referral to come into the food pantry.”
The pantry’s influence has spread around the Boston area, says the article. Hiralall has advised nearly 100 other hospital systems, and the Greater Boston Food Bank, which provides much of the Preventive Food Pantry’s stock, has been expanding its work with other health institutions. Among other initiatives, that has led to organizations delivering meals for those with cancer, HIV/AIDS, diabetes and other chronic illnesses.
Good practical ideas spread. And you don’t have to be a dietitian to share these skills, “My mom just retired from a food pantry,” wrote one poster on Reddit, “and one of the biggest lessons I've learned from her time there is that the more complex it is to cook something, the harder it is for them to give it away. She could give a can of beans to anyone, but to give a bag of dry beans she needed to be sure that the person had the knowledge, tools, and ability to cook dry beans.”
Meaningful change happens at a practical level when we recognize that these issues are interconnected - that there is no one ‘silver bullet’ answer.