Michelle Berger Marshall, MS, RD, LDN has the challenge and opportunity of helping both the national office and the network of 202 member food banks move forward to embrace a healthier food agenda. She has been with the organization in a variety of roles for three years. Prior to that she had broad experience with organizations like WIC and as a nutritional instructor at Kendall College, Chicago. I spoke to Michelle last week.
This blog encourages food banks to evolve towards a preventative healthcare approach with the idea that they will be able to find a new position of strength from which to leverage food and education to bring lasting changes in community health. How does this sit with what you are doing?
I’m a dietician and my husband is a physician, so we often have discussions about this area. If I succeed at my job as a dietician, I would hope to make his job far less difficult. Most of the people he is seeing in public health clinics have conditions which at the very least are exacerbated by diet. Prevention is the only way we can get back on track with the health of this country, and food banks have a relatively untapped power to address some of these complex issues in a simple way.
On your ‘From Hunger to Health’ website, you have laid out a framework of change that is incredibly powerful. As we ourselves have tried to engage with ‘public health’ organizations, it has been interesting to see what a disconnect there is between those who consider themselves anti-hunger advocates and those who have more of a community health or healthcare focus. We have a lot of work to do to bridge these conversations.
How would you typify the split?
One issue is that the public health sector traditionally doesn’t know or talk about food insecurity. At the same time I don’t think that anti-hunger groups have considered they are promoting or providing health. We find it easy to talk about negative aspects, like children not being able to concentrate in school without proper nutrition, but we haven’t been able to holistically tell the story about how all elements of the health argument connect together. However, we have made strides in making sure that we are now at the table with public health. At the local level, more food banks are joining obesity coalitions and such, and we are doing the same at the national level.
My belief is that for these partnerships to work, both sides have to bring something the other group wants to the table so that it becomes more than another well-meaning but ineffective conversation around nutrition. Food banks have an incredibly valuable asset – their clientele. We also have the food that can draw people to programs and screenings. If our local public health department are running a diabetes screening, that is not going to provoke a stampede to attend. But food is always a draw. Our Healthy School Pantry program is getting huge interest from our public health, because we bring back the same population each month. That is the kind of data they want, and the kind they can share with us to help us with our evaluations – that is what they bring to the table.
Absolutely, and the Bristol Myers Squibb Diabetes Project has been the perfect tool for us to begin to build closer links. We’re 9 months into 3 years of the pilot. Over the next year we will get some great data which can inform future projects. It has sparked a lot of interest. (An explanation of this Project is contained at the bottom of this post) I agree with your analysis on these blog pages that foundations are driving a lot of the new emphasis about impact, and in many ways we haven’t been able to provide that kind of demonstration of ‘here is the intervention and here is the impact.’ We as a network have a ways to go, but we’re getting there. We’re trying to bring in public health nutritionists and get them engaged in our projects to help us evaluate them. We recently undertook a nutritional analysis of the Backpack Program, with the University of Minnesota School of Public Health. ( Abstract or Final Report) Feeding America’s 2014 Hunger study will also include a series of health related questions for the first time.
We always wrestle with language in this field. ‘Hunger’ is easily understood and can raise certain kinds of dollars, but is not always as accurate as ‘food insecurity’ which as an emotive rallying cry hasn’t exactly taken America by storm. Nevertheless, food security and nutritional health are so closely tied together that we are stuck with it for the foreseeable future. What is your definition of optimal food security?
We use the USDA definition (access by all people at all times to enough nutritious food for an active, healthy life). But I try to remind people that the key element of that is ‘active and healthy’ and I think that when we bring ourselves back to our core mission and to Vicki Escarra’s (Feeding America CEO) remarks at the recent Summit in Detroit, one part of our mission is moving food, but the other is addressing long-term food insecurity, and this makes us all think differently, not only about the types of food we are providing, but our engagement and the range of our activities in making sure that people can afford and access and consume the food that we know (and they know) is health promoting.
You have been heavily involved with the Nutrition Task Force, which produced a draft report that was discussed at Regional Feeding America meetings last year, and then I have not heard a lot more since about it being integral to their upcoming new strategic plan.
No, that’s not the case. The discovery and research phases are now over, and we are at the point where we are deciding what things we want to do, from policy down to technology and food sourcing strategies, and with incentivizing certain sorts of foods. The structure and foundation is there. These issues were brought up in strategic planning sessions, especially in the ‘Evolution of the Network’, and the recommendations coming out of our group are piloting strategies to help the network move in this direction.
Let’s talk a little bit about the challenges of rolling out the task force recommendations and the nutrition agenda in general across a diverse network. It feels like there is a lot more direct pressure from the Feeding America National Office on an area like food safety, whereas it can feel like nutrition is still a ‘would be nice, but we’re not going to push it too hard’ type thing.
As to the network, the overall interest has gone way past those you might predict would be interested.
What, us hippy Californians? You can say it Michelle.
No, you said it, Erik. We find many food banks across the country, large and small who want to take a more holistic approach. In the 18 months we have worked on this, the conversations we have had with the network have really evolved due to increased public awareness countrywide. People know about the diet-related disease crisis, and things like HBO’s Weight of the Nation will only increase awareness.
From the National Office perspective we want to make sure that nutrition is not a stand alone initiative and that we have a cross-functional charge – with our food sourcing team, our policy team, our philanthropy team, communications and research all acting in concert. That way it becomes less likely to drop off the agenda. We also have strong leadership support, which is vital for success.
What other challenges are there?
Lack of information about the food in our system. We all face descriptions of foods that can vary wildly, dependent on how the information is entered by someone receiving in the warehouse. It is often inconsistent, and more detailed information will need to be an key evolution. The same is true with the way that we measure nutritious pounds. We are looking at ways to do this, within our existing system constraints (31 categories) and trying to limit these to be more consistent with the ‘My Plate’ system, so we can use this as a platform. Down the line we want to look at long-term solutions to incentivize the sourcing and distribution of foods that are more in line with the dietary guidelines.
Will this be based on CHOP? (The Choose Healthy Options Program – a system first developed by Pittsburgh, which we use our own version of, which ranks the food in our warehouse as red (for low nutritional value) through amber and green (high nutritional value). It helps encourage us to tracking our abilities to source more nutritious food and also helps provide a guide to our 290 member agencies and programs about selecting the best items for their clients. Lots of green and maybe one red item).
No, CHOP is more of a nutrient analysis approach, which makes sense if you are looking at similar types of the same food, but the advisory team wanted us to move in a direction that was aligning more with the external environment. We want to promote foods that are in line with the dietary guidelines, so whole grains, fruits and vegetables, lean proteins and low-fat dairy. We also want to think about the negative nutrients that we want to limit – sodium, sugar, saturated fats. So the difference with CHOP is that we want to focus on food groups first.
What other perceptions in the network challenge the adoption of a nutrition-based approach?
One concern is that if we focus too much on nutrition and nutritious food, we simply won’t be able to meet the need (i.e. quantity vs. quality). This mentality is deeply tied to how we currently measure our success – in pounds. At the same time, what’s exciting is that as many members move in the direction of moving more produce and supporting efforts to not just move food but provide education, benefit assistance and community food security efforts, we start to see a significant shift in how we all think about our collective impact and our definition of success. At this year’s network summit, “measuring something in addition to pounds” came up countless times—now it’s time for all of us to determine what those other measures can and should be.
And then of course there is the argument that we are just emergency food providers, which has been debunked by Feeding America’s own recent report. We are providing a significant contribution to clients diets, so our previous role as Calorie Banks could actually have been making clients less healthy and more hungry.
One of my colleagues challenged that ‘we’re only an emergency response’ theory by turning it around—perhaps because we have limited resources and very few chances to have an impact on our clients health and well-being, that this in fact justifies why maximizing those opportunities is so critical. In that sense the question becomes not ‘why us?’, but ‘who else but us?’
What about the issue of choice? When I first put forward some of my ideas when Santa Barbara was holding the Western Region Conference back in 2010, some ordinarily pussy cat food bankers became rabid dogs when they discovered that in Santa Barbara ditch the candy and soda that comes to us rather than distribute it. My argument was that this choice already exists. It is very easy to get candy, but much harder to get nutrient dense food.
The ‘food police’ argument, yes. Within our network we talk about choices a lot, choice pantries, client choice, the choice system etc. I always find quite perplexing that when we bring up nutrition the opponents of this shift immediately use “client choice” as a reason not to focus on healthy food. I just have never understood this. Given the data and research surrounding food deserts, food access and the inequities that exist in so many communities (many of which are served by our network) it seems to me that by focusing and securing more healthy foods within our network, we are in actuality increasing the choices available for our clients, not decreasing them.
To me, the highlight of the work of the Nutrition Task Force has been the focus on ‘foods to encourage.’ Taking a positive approach is a wonderful way to nullify the ‘food police’ and other areas of concern.
I’m glad you think that. The framework of “Foods to Encourage” outlines the food groups promoted in the 2010 Dietary Guidelines and serves as a general philosophy to help guide everything from food sourcing to communication and education. Furthermore and most importantly it allows us to continue to talk about food as food, while still allowing for food banks to adopt more detailed nutrient based evaluation systems to make decisions within food categories should they so choose.
Food is a powerful modifier in our life, it can bring us down a pathway to good health or one that leads to poor health.
Exactly. Every person on the planet has a relationship and personal experience with, (and subsequently an opinion about) food, it’s a struggle to have an objective dialogue about the issues. In some ways that is what makes these issues so challenging to tackle. Food has power, is often emotionally charged, deeply rooted in one’s culture and community, and provides much more than just energy and nutrients. When we attempt to make black and white decisions, it doesn’t take long before we realize when it comes to food and nutrition there will always be a lot of gray.
Perhaps key to all of this is unlocking the power of the communities themselves, to fight for an environment that allows all people to make the choices that allow them to nourish their families and live healthy, productive lives. As the food bank network we need to see our work as part of the solution today and in the long-term, our core work of hunger-relief does not need to be mutually exclusive of health promotion or vice versa. Everyone brings something to the table and I tend to believe food banks know food better than any other group.
Where would you like Feeding America and the Network to be in 5 years from now?
I would like to see nutrition fully integrated into how we see ourselves as an organization. Currently, you might go to our website and we talk about food security and hunger and then you have to go to different page to find out about nutrition. The earlier disconnect that I talked about with public health is also there to some extent within our own organizations. To truly bring together the goals of better nutrition and building food secure communities requires full integration. It needs to become engrained in how we do business, talk about ourselves and envision our future.
Thanks Michelle for all your great work.
BRISTOL MYERS-SQUIBB/FEEDING AMERICA DIABETES PROJECT
The Need: Individuals who have immediate food needs may be at risk for nutrition-related problems such as type 2 diabetes. For all diabetics, diet is a critical part of managing their disease type. For diabetics who are also facing food insecurity, maintaining a healthy diet can be nearly impossible, however. A research study conducted by the University of California at San Francisco found that adults living with the most severe levels of food insecurity had more than twice the risk of diabetes than adults who have ready access to healthy foods. By providing nutrient-dense food and nutrition and disease education, food banks can help their own clients with type 2 diabetes and those referred by health centers adhere to the diet and lifestyle changes that are prescribed, but are impractical due to lack of access and affordability.
The Project: Feeding America and 3 member food banks in Texas, Ohio and California will collaborate with health care providers to improve the health outcomes of individuals who are food insecure or at risk for food insecurity and also affected by type 2 diabetes. They will create and pilot bi-directional food bank-health center partnerships that will provide diabetes screening, care coordination, nutrition and disease education, and healthy foods. Feeding America will evaluate how well the project improves diagnosis of diabetes, adherence to diabetes treatment, increases self-care skills, maintains or increases mental wellness, lowers risk or presence of depressive symptoms, and improves specific physical outcomes related to type 2 diabetes such as Ha1c.
Foodbanks participating include:
Food Bank of Corpus Christi www.foodbankcc.com
Food Bank of Redwood Empire www.refb.org/html/innovative_programs.html
Mid Ohio Food Bank www.midohiofoodbank.org/pdfs/EHhd/BMS-MOF-Release-Together-on-Diabetes.pdf