The three year old I was examining was grumpy and uncooperative. His mom assured me she had no concerns about his development, but I wasn’t so sure – he appeared withdrawn and nonverbal to my eyes.  Attempting to see more interaction, I asked if I could offer him some graham crackers. His eyes lit up, and he moved quickly to my side. “Yes, please” he said, and put his hand in mine as we sought out the snack together. We returned to the exam room, where he ate crackers, then engaged in an animated (and informed!) conversation about fire engines as he happily cooperated with the exam. I looked more closely at mom, now, and saw fatigue and worry, peeked at the baby sister nursing in mom’s arms, and considered the possibility that food insecurity was impacting the health and future of this family.

My medical care can address children’s health and developmental problems as they arise, and I can protect them from infections with immunizations, but how can physicians and healthcare systems provide the crucial prescription for reliable access to nutritious food?

The Affordable Care Act mandates nonprofit hospitals and public health organizations, in order to maintain their tax exempt status, to improve community health by conducting a formal community health needs assessment every three years and then implementing community benefits to address identified needs. Many health facilities across the nation have conducted these assessments and over and over again they find that access to and ability to afford nutritious foods are major health concerns in the community. Taking action to address community needs that impact health requires creativity.  It challenges us to think outside the boxes we’ve known, and extend to all opportunities for the fundamental elements of wellness. While improved access to healthcare is a beginning, access alone will not substantially change the health of our country.  Disparities in the social context of people’s lives – sometimes called the “social determinants of health”, such as nutrition, housing, safety, education, and others, contribute to the poor health of too many of our neighbors and our children’s classmates. Of these disparities, nutrition and access to healthful food may be the easiest to change. Health care systems across the nation can take – and are taking –  big and small steps to improve and solve hunger.

Some of their efforts include:

1. Using the Hunger Vital Sign^TM to identify individuals and families at-risk of food insecurity and bringing it to the attention of care providers, medical social workers or community health workers who can intervene and help.
2. Connecting patients to the Supplemental Nutrition Assistance Program (SNAP), the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and other food assistance programs and resources in their neighborhoods. My hospital has created an order in our electronic medical record, that auto faxes a referral to Food Assistance Outreach workers in our community.
3. On-site food shelves or pantries, that provide immediate access to a bag of groceries to take home, often with nutrition lessons or healthy recipes included.
4. Hospital nutrition service participation as a site of the federal Summer Food Service Program which allows the cafeteria at my hospital to serve a pre-selected menu of lunch to all children up to age 18 years, Monday through Friday for 12 weeks over the summer.
5. Subsidized or funded community produce deliveries that bring the produce of local growers to medical sites for free or low cost distribution to patients on a regular basis, as well as sponsorship of community gardens.

The ripple effect of efforts like these is potentially profound. Healthcare providers reinforce their health messages by walking the walk, not just talking the talk about the importance of nutrition. Families rate their providers and sites of care more highly in terms of the care they receive, often expressing gratitude for a demonstration of care that goes above and beyond the traditional scope of care.  Alleviating household food insecurity has been associated with better physical and mental health, decreased hospitalizations and emergency department utilization, improved child development and school performance, improved adherence to medication, and deeper engagement with health care. Those in need find services at the same site of their medical care, in a trusted environment that values and preserves dignity.

Health care professionals and infrastructure are uniquely able to alleviate food insecurity within their communities in ways that allow everyone – patients and families, providers, healthcare systems, and communities – to reap tremendous benefit. Isn’t it time we all simultaneously pushed our boundaries and built upon our strengths, to demonstrate the difference we can make?