When the Great Recession hit in 2008, I immediately began to worry about its impacts on the bodies of the very young patients in my Growth and Development clinic at Arkansas Children’s Hospital (ACH) in Little Rock. Moreover, the data we collect in the Pediatric Emergency Department corroborated what I sensed from my patients to be true: families with young children were increasingly finding it hard to afford enough food for the whole family, in other words they were food insecure. When we took a closer look at our data, from 1998 through 2007, food insecurity rates remained stable among families with children under the age of three in Little Rock, but in 2008 alone rates of food insecurity doubled to more than 20%. This devastating increase in hardship was seen in my clinic in patients who struggled to gain weight because there just was not enough food to go around.  And that was not the only challenge, the parents of these sick children also struggled to find enough money each month to pay rent, utility, and medical bills.

I could not let this suffering go unnoticed and also knew that as a member of a healthcare institution, we had to do something about it. I discussed the connection between rising food insecurity rates and decreasing child health outcomes in meetings with colleagues, hospital leadership, and officials around Arkansas trying to raise awareness of the problem and work towards solutions.  I sought support in creating programs to alleviate hunger across the state and at ACH. After many conversations and the establishment of two committees to generate and implement ideas, ACH and the state of Arkansas have started to address and alleviate food insecurity through initiatives to feed children in the summer when there are no school meals, immediately when the problem is identified, and at home through SNAP and WIC.

In 2013, ACH began offering summer meals, through the federally-funded Summer Feeding Program. All children under the age of 18 are eligible to receive a free meal in our on-campus cafeteria during the summer months when school is not in session. Through this program, we do more than just feed children – we alleviate the stress of parents who want to provide for their family and just cannot make ends meet.  Mothers have been seen crying after their children received free lunch because they know that without the help, they and their children would have been forced to skip yet another meal.  We have expanded this program to a year-round meal service, where all children on our campus are eligible to receive a free meal every day between the hours of 10am-5pm. As of June we have provided more than 1700 lunches to our patients and their siblings. Federal support for those meals comes through another important and effective federal program, the Child and Adult Care Food Program.

Beyond meals at the hospital, we want to ensure that when we find out that a family is hungry, we can address it right away.  To that end, I have been a driver for a pilot project involving an on-site food pantry that would provide families with a bag of food that they can take home and prepare. This project will resemble successful models of hospital food pantries pioneered by leaders at Boston Medical Center and Hennepin County Medical Center.

Savvy shopping can certainly also help stretch limited resources.  Through a partnership with the Arkansas Hunger Relief Alliance and supported by a grant from Share our Strength, we started the  Cooking Matters program and invited caregivers to participate in grocery store tours where tour guides discuss ways of maximizing constrained financial resources while still purchasing healthy, nutritious foods. In addition, we have collaborated with the Arkansas Cooperative Extension agency that will be providing nutrition education materials in our waiting areas.

Although the benefits of nutrition education and emergency food assistance cannot be underestimated, families still find themselves coming up short of money at the grocery store. Why?  Well, providing a meal or a bag of food is like treating a sick patient. As a pediatrician, some of the medicines I prescribe are absolutely critical but seek to alleviate the symptoms of a disease, rather than preventing it in the first place. Other treatments or advice might actually prevent or cure the disease. In the same way, we must tackle the problem of food insecurity.  More must be done so all of my patients’ parents can provide meals for them at home, every day, not just when they are at the hospital. My clinical experience and my research work tell me that the Supplemental Nutrition Assistance Program (SNAP, formerly called food stamps) and the Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) are the kinds of medicines my colleagues and I can prescribe that help to move us toward preventing and curing the ‘disease’ of food insecurity.  In fact, they are also public health programs that sustain the health and development of children.  That’s why we provide assistance with SNAP applications right in the hospital – we want to ensure that eligible families are successfully enrolling in those programs. Currently, ACH financial counselors help with SNAP applications.  In the past 18 months, over 400 applications have been submitted by the families of patients.

We know, however, that we can enroll even more families if we clear away the barriers. Because of the reforms in health insurance markets with the implementation of the Affordable Care Act, Medicaid and SNAP applications, which were once connected, are no longer integrated.  In disconnecting the applications, stumbling blocks have been created in the path to accessing support. Now families must provide the same paperwork for two separate programs, creating more bureaucratic hassle for families and for the state.  For that reason, I support the efforts to reintegrate Medicaid and SNAP and urge that the change be implemented in a timely manner.

For families who are eligible for WIC, we are working on a plan to open a WIC office onsite that will assist caregivers in the application process. Recently, the USDA awarded ACH a grant for start-up costs, making this exciting plan possible.  With such close collaboration and easy referral to a WIC office on our own campus, we plan to prevent and treat the ‘disease’ by enrolling families in preventive programs before they become food insecure.

It is my job as a pediatrician to ensure that children – not just my patients – are healthy and have the best opportunity to grow. One of the ways we will reach that goal is by working with administrators, local and state officials, and community groups around the state to provide basic resources to people in the places they already visit as they seek to put food on the table for their children every day. The U.S. is known for health care innovation.  Let us bolster that reputation by innovating again… this time by ensuring that our friends, neighbors – and patients – who struggle to fulfill their basic needs, will find healing and help within the walls of the hospital.