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Every day in Toledo, Ohio, a child wakes up and wonders when and where they're next meal will come from. It's a city where 35% of low-income families are concerned about having enough food. It's a place with one of the fastest rates of poverty growth in the nation.

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And it's a town where ProMedica is working to eliminate food insecurity and the health issues it causes.

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With more than 17.4 million U.S. households facing hunger, or one in every seven households nationwide, it is a dire public health concern. Food insecurity and malnutrition impact individuals across the age spectrum – from unborn babies to the elderly. It also causes financial burdens for healthcare systems, government, insurance providers and taxpayers, especially as more people become insured under healthcare reform. By working collaboratively, healthcare professionals can ensure the fight against hunger is a winnable battle for the sake of the country's most vulnerable residents, as well as for the stability and future of our communities.

At ProMedica, a not-for-profit, mission-driven health system serving northwest Ohio and southeast Michigan, five years ago we became increasing aware of the link between hunger and the nation's obesity epidemic. It had become difficult to successfully address obesity without looking at community access to nutritious, affordable food. This knowledge prompted us to further investigate the health-related impact of hunger and develop a number of initiatives to solve this issue in our communities.

The first thing we realized is that we can't do it alone. We developed collaborations with local, regional and national partners to improve the availability of and access to nutritious food, increase national awareness of hunger as a health issue and highlight the importance of studying the effectiveness of strategies and tactics that address hunger. In many cases, these partnerships and program have led to addressing and improving other social determinants of health, including education, employment and housing.

Food Reclamation
Early on, we identified food reclamation as one initiative that would be relatively easy and inexpensive to launch. ProMedica employees repackage unserved food that otherwise would be thrown out at a local casino and our hospital cafeterias. The food is delivered to homeless shelters and other feeding sites across the community by our local partner Seagate Food Bank. Since its inception in 2013, the program has reclaimed more than 275,000 pounds of good, which equates to approximately 200,000 meals.

Food Insecurity Screening
In 2014, ProMedica began screening hospital patients for hunger and food insecurity. During the admission process, patients complete a two-question screen that has been validated by Children's Health Watch, a nonpartisan network of pediatricians, public health researchers and children's health and policy experts committed to improving children's health in America. Hospital patients who are identified as food insecure are referred to a social worker or care navigator for additional assessment. At discharge, patients who need assistance are given an emergency, one-day food supply and connected to community resources for further support.

ProMedica's primary care physician practices have taken the screening process a step further. Food insecure patients are referred to ProMedica's food pharmacy where they will receive several days of healthy food for themselves and their household. Macos catalina bootable usb on windows. The food is compliant with the patient's nutrition dependent diagnosis so diabetic patients are provided low-sugar options and hypertensive patients are provided low-sodium options. Patients also receive information about community resources for on-going assistance and can meet with a dietitian for additional education. They are able to visit the food pharmacy once every 30 days for up to six months before requiring a new prescription. Since starting in 2015, the food pharmacy has assisted more than 3,000 households.

ProMedica is conducting a research study to assess the effectiveness of the program. Our physician group, population health and research teams are using data from our electronic health record and claims to determine the future direction of the program. They are analyzing the number of utilizations per patient, utilization of other medical services, the medical profile of the patients including the presence of chronic disease and mental health diagnoses, notable changes to health since utilizing the food pharmacy, demographic data, screening percentage by physician practice and percentage of positive screens by practice and percentage of filled/unfilled referrals by practice. Additionally, food pharmacy patients complete a survey about food insecurity, quality of life and mental health status at their initial visit and three and six months later.

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Improving Access to Nutritious Food
For many individuals, the challenge of eating nutritious and affordable food is compounded due to lack of access. Many live in neighborhoods designated as food deserts, low-income areas without supermarkets offering fresh produce and other healthy food. ProMedica has several interventions to combat this issue:

Mobile Farmers Markets
To help improve access to fresh fruits and vegetables in a rural Michigan county where two ProMedica hospitals are located, we secured a U.S. Department of Agriculture grant in 2013 to fund a Veggie Mobile. The van stops at senior centers and other community locations to sell and distribute fresh produce. In 2015, ProMedica was awarded a second USDA grant to assist Seagate Foodbank in expanding its mobile farmers market. This mobile market visits senior housing complexes, community centers and other underserved neighborhoods and provides an opportunity for residents to access fresh fruits and vegetables. The program also provides nutrition counseling and education by a registered dietitian during expanded stops.

Market on the Green Grocery Store
With the help of philanthropist Russell Ebeid, in December 2015, ProMedica opened a 5,000 square-foot market in a food desert in Toledo, Ohio as part of the ProMedica Ebeid Institute for Population Health. Market on the Green features fresh fruits and vegetables, meats, dairy, baked goods and food basics in addition to sundry items with the intention of being a site where an individual or family can fill their grocery needs. Additionally, it is an employee training program where local residents are hired into a 12-month program to learn all aspects of the Market and other basic business and retail skills. When their initial year is complete, they will have the opportunity to move into another ProMedica position or to one with a community partner making way for a new group of trainees.

The second floor of the Market building will house a teaching kitchen and classroom space where individuals and families can learn healthy cooking techniques, menu planning and more. Financial literacy programming will also be offered.

ProMedica believes this model can transform the neighborhood and has engaged The University of Toledo and Gretchen Swanson Center for Nutrition for a long-term study focused on the behavioral change of customers as well as broad neighborhood change and stabilization metrics. This research will quantify the impact of the Ebeid Institute and Market on the individuals and the neighborhood.

National Collaboration
Our efforts to eliminate this public health issue led to several national partnerships. ProMedica is a member of Stakeholder Health, a coalition of healthcare systems that work with the U.S. Department of Health and Human Services to improve public health through innovative practices and community partnerships. The coalition aims to lower healthcare costs, improve access to care, elevate the health status of the communities it serves and reduce health disparities. We are sharing what we are learning and gleaning from other's efforts.

To further develop anti-hunger efforts among healthcare organizations and their partners, ProMedica has partnered with the USDA and Alliance to End Hunger to hold hunger summits nationwide. Our first summit was held in February 2014 on Capitol Hill. Regional summits have taken place in several of the USDA's regions including Chicago, Atlanta, Albuquerque and New York. Another summit is scheduled in San Bernardino in the fall of 2016. These summits are designed to motivate healthcare organizations to work with community partners on anti-hunger efforts. They also serve to encourage local, state and national government officials to protect food-related policies and programs.

The national summits identified a need for a coalition rooted in healthcare to focus on hunger as a health issue and other social determinants of health. To that end, in October 2015, ProMedica in partnership with the AARP Foundation, co-founded and launched The Root Cause Coalition, headquartered in Washington, DC. The Mission of The Coalition is to address the social determinants of health, with specific emphasis on hunger as a public health issue. The Coalition commissions and engages in relevant research on the correlation of hunger to overall health, advocates for relevant public policy and develops and deploys effective strategies and programs that focus on meeting the access, nutrition and education needs faced by individuals and communities. The Coalition will host a National Summit on the Social Determinants of Health in December, in Chicago. (To learn more about the summit, visit www.rootcausecoalition.org).

What's Next?
Hunger harms a community's health and well-being. As our focus shifts to population health, the healthcare industry must go beyond its four walls and collaborate to address basic needs. By starting with hunger as a health issue through strategic, purposeful and intentional initiatives, we can create an improved model to deliver better healthcare.

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Randy Oostra, DM, FACHE, is president and CEO of ProMedica, a mission-based, not-for-profit healthcare organization serving northwest Ohio and southeast Michigan. The 12-hospital system has more than 15,000 employees, 2,100 physicians and more than 800 healthcare providers. For more information about ProMedica, visit www.promedica.org/aboutus.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.​

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