Hunger is always perceived as a hyper-local issue. Smaller scale cash donors within a city or town in your service area are often very concerned that their dollars are spent for food within that community. They don’t want it to go to those folks fifty miles away who might as well be in a whole other universe. We might consider this as a parochial attitude and believe that these people don’t see the bigger picture like we do.
But, what if they’re right?
What if we’re so obsessed with total impact / poundage / meal gaps and systemic change that we can’t focus on the type of grass roots neighborhood level work which can be truly successful and sustainable?
That’s someone else’s job, right? A partner agency who can get into the weeds while we keep that big food machine humming. But we used to say that about a lot of things, like SNAP outreach or nutrition education. I’ve also always been concerned that we’re accidentally creating a ‘new norm’ of food security in that people will get increasingly used to saying: “Yes, of course I’m food secure, because I can go to this pantry on this day and then that pantry on the other day.”
In Santa Barbara, we are ready to pilot ‘Healthy Neighborhood’ programs designed to be sustainable local solutions to food security and food literacy at the micro level. They represent the next step in the (occasionally painful) realization that we can’t make or keep a community food secure by only working with those who most need our services.
Ouch, what did I just say?
Do you think we have resources to just spray around? Unlike you, we’re not in ritzy Santa Barbara with sun and sand and aging movie stars. We live in the real world and we have to concentrate resources on those most in need.
Yes, I get that perception, but we are a medium-sized food bank with a modest $4 million cash budget where cash is always tight. It would be easy for us to walk away from such an approach, but we can’t. Let me make clear that our food resources unquestionably go only to those who really need them. But educational and community building resources are going to have to be offered wider than that. Those that can pay will pay or subsidize others. While this creates short-term financial pain, it will also broaden and deepen the donor base and introduce new perceptions of the organization as a good for everyone in the community, not just those ‘disadvantaged others.’ (aka ‘the needy,’)
Consequently, Foodbank of Santa Barbara County’s Healthy Neighborhoods Initiative marks a major pivot in approach, transitioning our work in neighborhoods of high poverty and food insecurity from a client-based to a family-based model. This initiative is designed to bring together a whole neighborhood of families in the effort to build a resilient and nutritionally healthy community, where food and health become the focus for community engagement, education and economic development.
Each pilot will be based around key physical locations, operating as Community Food Access Centers, which are place-based, food-centric neighborhood revitalization efforts, uniting multiple educational, nutrition and community development functions. These centers will have a family-based focus. You may be familiar with The Stop in Toronto Canada. At this stage of the initiative’s evolution we don’t have the luxury of building one of these or utilizing a facility just for this purpose, so we have to make use of existing places with their own range of activities – community centers, schools etc.
Initially, the center will only operate one day a week, but it will be intensive. Food and age-appropriate education will be provided for the whole family to attend at a time convenient to them. Childcare and basic food literacy training will be provided for young children; culinary skills will be provided for teens. Education will be culturally as well as age appropriate.
Though there is one day per week where education and services are focused, other satellite activities will happen at other times. There will be regular communication across a number of media and communication platforms to keep the neighborhood informed and involved in the effort. Centers in targeted neighborhoods will provide low-income families with a specific place to go, where people that you know and trust will be teaching and learning with you. The idea is to break the cycle of poverty and food insecurity by including all generations; they will also work to channel partner services in a more culturally-appropriate and culturally-tailored manner, in an environment in which families and neighborhoods feel comfortable coming together and learning with each other.
Providing the life-blood of the Community Food Access Centers and supporting community involvement are neighborhood networks of volunteers – Nutrition Advocates – that provide bi-lingual peer-to-peer education, empowering community members to improve their health. Food-related programs offer the “idea bridge” for others to provide skills and knowledge training.
Other elements of this strategy are:
Small Food Business Incubator – Encouraging entry into local food economy by providing business, food safety and marketing training to Nutrition Advocates and food entrepreneurs, and the opportunity to develop small businesses.
Food as MedicinePrograms – Diabetes Education/ nutrition education/diabetes specific food support programs.
This approach builds on existing geographically local impact groups that we have been working on for the last couple of years and the relationships that have come out of them.
Collective impact projects come and go. Funding comes and goes. The idea here is to find a low-risk approach, because it involves empowering the community to help itself. Networks and relationships will grow, increasing community cohesiveness and requiring less outside stimulus.
Ultimately, a neighborhood approach does not rely on the desire to help ‘others’ but on the practical need to help ‘each other,’ by living in a neighborhood where mutual support to obtain and keep good health reframes how people engage with each other. This is incredibly challenging to our ‘big’ way of operating, but it is also exciting, representing the opportunity for a much more inclusive and empowering approach to our work, and the opportunities for new approaches to how we fund that work.
I’ll let you know how we get on.
In the meantime, why don’t you consider taking a walk and building food security street by street.
One day not too long from today, funding for organizations like ours will be heavily based on the social impact returns we can bring against the financial investment made. We will have to make our cost benefit pitch over what improvements in health can we bring. Who are the specific groups we will touch and what specific disease areas will we help to mitigate or eradicate? How much money can we save the City, County, State and Nation in healthcare costs? Over what period can we do it?
If we can put forward a persuasive argument, we will receive funding with the remit to deliver on our proposals. Our food and education programs and our demonstrated ability to link to a continuum of community support and empowerment for under-resourced individuals and families will help us make a strong case.
We will then have to evaluate and measure impacts and wrangle and present the kind of data that makes our current activities in this area seem equivalent to counting on our fingers.
It could be like Feeding America’s quadriannual Hunger Study – every day!
Before you wake up screaming in sweat-soaked sheets, we are not there yet. This may be a world that you don’t want to get to. However, it is coming, whether you like it or not and we need to position ourselves by our deeds to demonstrate the hugely beneficial public health impacts of food banks.
Sure, I am a nice guy who wants to help people be healthy and feel positive about what they can achieve in life for themselves, their families and their communities. But I also care about the long-term direction and viability of organizations and a network like ours. We need financial resources to do our work, and our march into the future is going to require mastery of juggling dual funding streams (charitable donations for food insecurity and provider service fee payments for health outcomes) to be able to survive over the coming decades.
From my cheap seat in the bleachers, hunger is no longer driving the national discussion in the way it did a few years ago. It is already viewed as a sub-component of poverty, which has morphed into the ‘real issue.’ The perception is now that the country has drifted in a situation where people find it incredibly difficult to improve their circumstances no matter how hard they work, no matter how much they take personal responsibility for their own situation.
Partnership with other organizations nationwide and locally is the only way to begin to take on both situational and generational poverty. Feeding America’s fledgling Collaborating for Clients (C4C) initiative is a great step in this direction. Here is a download for some FAQ’s about this: Collaborating for Clients FAQ_1.27.2014
The vital next step after that is ‘collaborating with clients’ to achieve the kind of sustainable transformations in local communities that will work long-term. The Federal government is not going to gallop in on an ethnically balanced white/brown/black horse and save the day. Those days are done. We have to help micro-communities connect and find their own solutions, and then turn around and use their own power and ability to work together to drive the national agenda from the bottom. I mean, what is the point of all this social networking crap unless we can get it to do something worthwhile, right?
Anyway, it’s clearly time for one of my pink happy pills to calm down, because all that is still a ways off and we want to help people be more nutritionally healthy right now.
And so, there is ‘preventative health’ which can be the second flank of a ‘pincer movement’ that enables us to come at the ingrained and complex problems of poverty from two different sides, utilizing different partners. Fighting poverty through job creation and community development is actually not enough in itself. If you improve people’s financial situation, you can make them food secure, but this doesn’t necessarily improve their health. However, if you work to help people improve their health, you give them skills (food literacy) that will be invaluable to them in times of scarcity or times of plenty.
I also think it is possible to steer the issue of poverty away from being a lightning rod for people’s knee-jerk political reactions and deep seated personal fears (oops, same thing) and into a more neutral territory where we treat the ravages of poverty as a public health issue that there can be broad consensus to rally around. That is a ways off, but I think it gives us somewhere to head for that is worth reaching for.
So that is the ‘why.’ What about the how? How can we engage with the current preventative healthcare framework and demonstrate our worth to be part of this fabric.
Below I lay out five different steps you can take. You can’t do all of these things at once (don’t tell my staff that, though), but achieving a win in any of these areas will give you some credibility and provide the foundation to broaden and deepen your health-related activities.
1. Diabetes is a great place to start:
Playing a part in diabetes care is one of the best initial possibilities for demonstrating the vital role we can play in community health. Obesity is much harder for us to prove the specific benefits of our role. (Even for us our food bank with 60% of our distributed product as fresh produce). Diabetes is much easier for us to demonstrate the success of our interventions.
For the last two years, the drug company Bristol-Myers Squibb has been funding pilot programs in diabetes care with three food banks across the country, each pursuing slightly different versions of partnership with local healthcare providers. (Here is some basic information on the project. More detailed data will be released soon.)BMS Diabetes Project 2014 The interim results of these studies provide us with some real data about food banks can play a vital role in screening, helping people control their condition, and also dealing with the huge swathe of ‘borderline diabetics.’ Here is a link to an informational website on this area, which has a lot of helpful info.
We are actively speaking to a number of local health providers in our county about running similar programs. Virtually all of them have been enthusiastic about this. It is a big problem, they can save a lot of money, and they also have funds available for this type of activity. We are still working through how the financial model will work, but we are increasingly looking for fee payments (by healthcare provider, not individuals) for the type of direct service that we are providing in the healthcare space. We can’t be apologetic about asking these organizations to pony up. Yes, people expect charitable hunger relief for $25 bucks and a turkey too big for someone’s oven, but I can assure you that they do not expect to get bona fide health interventions so cheaply.
2. Consider providing training in screening for food insecurity for medical staff:
Oregon and its food bank are way ahead on this one. (what was that Ron Burgundy was saying in Anchorman II about only leaving the country once – when he went to Salem, Oregon?). They have a dedicated site with excellent online and written training materials for medical staff centered around utilizing the existing USDA two question survey to gauge food insecurity.
Of course, medical staff will have a full-blown panic attack if you attempt to suggest adding anything more to the huge clipboard of paperwork needed to be filled in on patient intake (waivers to waive the right to waive waivers and the like). However, persuasive arguments can be made – continuing education points are available in the Oregon model, for which there are existing requirements for medical staff to obtain. Also, being aware that a patient is in a food insecure household is a pretty useful thing to know when you are looking at strategies to improve the health of that patient.
The other major potential sweetener is the possibility of providing doctors with the ability to ‘write prescriptions’ for fresh produce for some patients. They could then bring these prescriptions to a food pantry (ideally one that would be open at that time) where they could receive some fresh produce. Medical staff like to have something to give patients, and even if they have to pay something to help contribute to the cost of fresh produce, it is still a small cost compared to other interventions they could offer.
3. Get in on the ‘Community Health Needs Assessments’ wagon train:
This was supposed to be our admittance ticket, our way of building relationships with local hospitals and health authorities. They are now mandated to see what is happening with the health of their communities and devise strategies to deal with these issues. Food insecurity is a significant portion of this reality, as well as the health conditions that optimum nutrition can help alleviate.
We actually contributed to our local plan a few months back in terms of being invited to a stakeholder interview roundtable. We are still at the stage where we were not considered partners, more a case of ‘we better ask a bunch of nonprofits what they think.’ Consequently not much significant has resulted from our modest involvement in this process. In your area, you may be able to insert yourself at a more opportune point in the process and be more involved. From our viewpoint, I figure that we need to get on with the other things we are doing in this area, and then when next time rolls around, things will have shifted significantly.
4. Stop whining that the bigger fish get all the fish food. Puff yourself up bigger to get bigger funding:
I am not talking about increasing the size of your organization, which may not be a good idea even if it is financially possible. What I mean is to link together with other food banks or similar organizations to run health based programs over a broader geographical area. While I may have my visionary moments, most of the strategies I pursue have a very pragmatic basis. Such is the case with this. Trying to get the Feds to cough up for the dire needs of those in hunger in Santa Barbara County is an uphill struggle. Why, dear reader, even you are smirking now. What do they know about hunger? We always have to deal with the kneejerk reaction of having one rich city in a county with rampant food insecurity and low food stamp uptake. (In the 58 California counties, only 14 have more food insecurity than Santa Barbara). Also, the reality is that if you are looking for health money not USDA food security money, a county of 400,000 is a gnat bite. They want big populaces to make significant impacts on regional numbers.
This is one of the reasons for the formation of the ‘Food Bank Health Alliance of the Central Coast.’ This is an aggregation (currently) of ourselves, Santa Cruz and Ventura Counties. Between us, we have a million and a half people. If we can get San Luis Obispo and Monterey County to join us we will have an unbroken line of sister organizations covering the whole coastal region that separates LA from San Francisco.
Our organizations are linked by MOU committing us to jointly seek for health related federal funding (though we’ll take money from USDA, Department of Defense, Smokey the Bear…). Marriages of convenience without shared values and objectives are a recipe for disaster – as I’m sure you’re all aware from your previous collaborations – however, this more open relationship is based on a shared outlook. This boils down to:
GOOD NUTRITION – Is the bedrock of our activities, sourcing and distributing as much nutrient dense food as possible. We also have nutrition and wellness policies so we can walk the talk (and help our member agencies do so).
COMMUNITY EMPOWERMENT AND DEVELOPMENT – As well as making a success of ‘feeding the line’ of people who are food insecure, we are also very focused on ‘shortening the line’ of those who will need help in the future. The only way to achieve this is through empowering the community to take control of its own nutritional challenges – on an individual and neighborhood level and upwards. This involves making those who were previously ‘clients’ into partners for healthy lifestyles and environments.
EVALUATION OF IMPACT – A need to move beyond measurement of outputs to demonstrating the efficacy of our actions on the public health and development of communities. We will additionally work to demonstrate wellness and self-sufficiency.
A HISTORY OF COOPERATION AND MUTUAL TRUST – We have a long shared history as members or partner distribution members of Feeding America, the national organization of Food Banks as well as the California Association of Food Banks.
There will doubtless be lots of challenges, different organizations used to running their own unique programs in their own idiosyncratic way. However, unless we can make this type of collaboration of very similar organizations work, then none of us have any hope at succeeding in collaborating with the wider groupings that will be necessary to have a true impact on poverty in America.
An ‘alliance’ like this needs large amounts of cash to grease the wheels and make it work, so stay tuned for results on how we’re doing. Or better yet, why wait to see whether we fall flat on our faces and put together your own regional collaborations. If the Feds don’t give you the money, they’ll only spend it on something really dumb, so you might as well go for it!
5. Lead with Seniors:
Often, funding to feed seniors is treated in a similar way to finding the money to feed homeless people. Besides a few highly motivated donors, these are the programs that it is harder to get broad funding for, so they tend to get paid for out of general operating expenses. It’s a shame, but scruffy dudes with matted beards or finicky grey hairs clipping coupons do not always excite funders. Consequently, it’s so easy to lead with kids and get funding for those kids. (I call it ‘taking candy with a baby’) Individual donors or foundations feel the heartstrings twang and they also think kids might be a better long-term investment. I have always muttered that ‘Kids are just the Seniors of tomorrow,’ but that hasn’t made much difference. I have been waiting for some perspective to shift or something to click for me in this area and I think it just did.
At a recent meeting with a major healthcare provider, he said: “Kids are basically healthy unless you really mess them up, but seniors are a significant expense.” If you think about it, asking the health world to pay up now to ease the problems kids will generate thirty years from now is asking too much. If we can help them keep seniors healthy and independent as long as possible, we can save them some serious cash in the here and now, not after they’ve retired or moved on. That is something that they would be prepared to invest in – and the sums would be a drop in the ocean compared to the increased expenses they face.
In this case I am thinking about a more integrated and expansive range of senior nutrition programs that move beyond the straightforward grocery bags or congregate feeding. These programs would have a nutrition and health element and that mesh more organically with existing health screening.
We are still putting together the right mix of ideas and partners before making a significant investment, but it has to happen and soon. We are seeing an explosion of need amongst seniors and what might be termed ‘pre-seniors’ (those close enough to retirement age that they are finding it very hard to get employed as people don’t want to invest training cash in them). Really, once you are in mid to late 50’s it gets harder and harder (So that’s why those Food Bank ED’s stay so long in their jobs!) To give an example of the type of programs we are looking at in the senior arena:
• A program providing ingredients for seniors to cook a meal together a couple of times a month at a community or senior center. This would give people motivation to keep their cooking skills going and also allows social contact, additional nutritional education and health screening from other healthcare groups.
• In seeking to meet the needs of our large Latino community, we are looking at a program that caters to the large number of grandparents who look after kids while their parents work. This program would also allow for a weekly meal in a community center where both generations would work together to cook a meal. This way, nutritional health and food literacy skills can be the focus for these two age groups, who if they disagree about a lot of things, are united in their belief that mom and dad can’t cook to save their lives, or that they are convinced they don’t have the time to. Again, this situation offers great health screening opportunities for diabetes etc.
• Meal delivery to seniors. In our area (and maybe yours) senior meal delivery has become a hot potato (or a reheated lukewarm potato, more like) with responsibility for the service being passed around. Meals on Wheels may be a large presence in your area or one that is suffering from a volunteer force that is figuratively and literally dying off. The reality in many places is either some kind of vacuum or spotty service at best. We are interested in investigating partnerships in this area. At one extreme, you can be like Feedmore in Virginia and create one big entity of MOW, food bank and community kitchen. At the other is at least more collaboration and integration within the range of services in your area. I know that Greater Chicago Food Depository has been piloting a program where health visitors drop off an ergonomic box of six frozen meals with low-income seniors that they visit. These are to be picked up from various centralized locations, and the frozen element allows delivery before food safety becomes a major issue. For the health visitors it is obviously an inconvenience but also provides something tangible that they can give people and that helps them make their numbers and keep their clients happy. This is a complex strategy and I know that there have been significant challenges with it, though this is clearly a direction worth pursuing and seeking the type of local and state reimbursement funding which would make it more financially viable.
It is up to you how tightly you are able to integrate this type of programming with the health screening and health treatment needs of seniors, but the tighter you do so, the more you guarantee a stream of funding. Food is still the draw to get involved in a program whether you are seven or seventy.
Feeding America recently published a report on Senior Hunger, which may provide some help to you in pushing for funding and partnership in this increasingly vital area of our operation.
Are the tactics I have suggested a distraction from your core mission of feeding people? I would argue that they enhance the mission in multiple ways. Take the suggestion around training medical staff to screen for food insecurity. Can you imagine how much your development staff will benefit from the type of new understanding that doctors and health teams will gain of both food insecurity and our work to eradicate it? People want to get involved when the discussion is good nutritional health, and now is the time to start leveraging our credibility and boots on the ground in this area.
People are doing new things in the food banking world. In our search to ‘shorten the line,’ we are getting involved in areas that we had not been involved with in the past – educational programs, anti-poverty or pro-community development work – not to mention all manner of strange new alliances and partnerships.
We are discovering that our existing organizational structures are not necessarily the most efficient vehicles for getting us where we want to go. ‘Feed The Line’ and ‘Shorten The Line’ can be like two sticky gears in a truck and if you are constantly crunching between them, your engine (read staff) can become overstressed and your gearbox (read budget) may get worn out with all the upshifting and downshifting.
A standard food bank operation can feel like like tank, rumbling along, and when the situation calls for us to get all nimble and ‘ninja,’ we can find it hard to change direction. We’re brute force powerful, but maybe not so suited for the asymmetrical challenges of tackling poverty or helping clients build social capital. How can we build the nimbleness of being able to deal with both micro and macro interventions within our humble and creaky org chart?
We all hate org charts because they have this way of deadening a living, breathing thing (If you have any doubt, check out the chart of the educational establishment below):
Then of course there is the org chart according to the Executive Director’s view of the world, which is much like Steve Jobs’ view:
For us to figure out what is the best structure for our organization, we need to start by being clear where we stand in relation to the community around us. [Here you can download a good SSIR article on the ‘Networked nonprofit‘]
When I am explaining to Foodbank supporters about the evolution of our mission, I talk about how we can no longer avoid looking ‘upstream’ of where we are, to try and understand and deal with what is driving so many people to our doors – typically situational or generational poverty.
I then tell them we need to consider what is ‘downstream’ of where we are operating – this means what are the true outcomes of our interaction with clients? It may be that their long-term health has not been affected as beneficially as we hoped. These ideas are summarized in the graphics I developed below:
So, how can we restructure to meet this enlarged understanding of how we are affected by, and in turn affect the world around us?
Let’s look at some ways in which food banks are organized around these elements of the mission.
THE CLASSIC FOOD BANK
The first model is the ‘Classic’ food bank. Unreconstructed, proudly focused on the core mission and seeing no need to evolve further. Not only is it structurally unsuited for any expanded mission, it doesn’t even want to consider the possibility of one.
Typically this food bank will be in a high need / low resource area, where the only mindset accepted is ‘running faster and faster to keep in the same place.’ (Yes, I know my food bank is in hoity-toity Santa Barbara, but we serve the whole County, and of the 58 California counties, only 14 have more food insecurity than ours, so I should be at least be allowed an opinion…end of self-justifying whine!)
Another factor is that whatever food bank we are in operates the way it does for a million historical and community reasons – many of which may be hidden under the surface. ‘We’ve always done it this way’ can be a common refrain. These food banks will probably carry on much as they are, shrinking a little in size as ‘recession sympathy’ dries up further. The lack of desire to face shifting realities may be failure of leadership at the board or ED level or it could be just a lack of strongly voiced desire for anything more from the community.
Lets look at two other structural models that are currently out there in food bank land.
The Remodel is basically taking the old structure and trying to add on a few additions. It might be teaching some nutrition education classes or having some involvement in SNAP outreach.
There are many food banks are in this grouping. Whatever gets added might be as a result of ED interest, community stimulus or Feeding America encouragement. The problem here is that because the organization was not structured for this additional mission, then the new initiatives can be like vestigial limbs hanging off the org chart or they shoved in some department that feels like its original remit has become distorted.
This can lead to new initiatives being left to die by staff who feel they are already overworked, or that the program will be starved of resources once it has been there a while and is more noticeable for the problems it is causing the organization as opposed to the ‘new program paint smell’ that was so useful for fundraising in the early stages.
THE SHINING CITY ON THE HILL
Of course the polar opposite of the ‘classic’ approach to food banking is what we might call the ‘We do it all’ or even the ‘Shining City on the Hill’ food bank. They stand out from all around them. They can be like a giant snowball rolling through town, picking up all manner of diverse activities: community gardens, job training, process kitchen etc etc. These activities are typically run by food bank staff. As someone remarked at the recent Feeding America ED forum, you’ve heard of ADD, this is called EDD.
This mode of operation tends to develop in places where the food bank is very much the ‘only game in town’ in terms of dwarfing other nonprofits, or having a large geographical area and considerable financial resources relative to the local nonprofit eco-system.
The general challenge with this approach is that it is expensive, difficult to sustain and challenging to coordinate. Also if you’re throwing a ton of programmatic outreach at the wall hoping some of it sticks, how do you know what element is really moving the needle, and what is well meaning but ultimately ineffectual?
CATALYST FOR CHANGE MODEL
I would like to suggest one additional approach –one that I believe our food bank is evolving into, which is more of a bottom-up ‘redesign’ and which could be called the ‘catalyst for change’ model.
The ‘Catalyst’ model means we create an uber goal – in our case ‘ending hunger in our service area AND transforming the health of the community through good nutrition.’ This goal allows us to partner with a full range of local health and service organizations and hunger relief becomes part of a positive goal that can be measured using public health indicators.
In reality, we still have our fingers in a bunch of pies, but the difference from the ‘we do it all model’ – and this is crucial – is that the food bank needs to remain value neutral over whether things are done either by them, by their existing agencies or whether achieving something requires new forms of partnership.
The overriding thing is that your organization commits to making sure that it happens one way or another, will evaluate the results and keep the process moving forward.
We expand what may already have been a long-term role as the encouragers of an ecosystem of community partners working to improve health and food security. The difference is that this time we want results and we want to be able to measure them. It could also mean that everyone’s programs might not be adjudged as wonderful as everyone else’s.
FB’s are perfectly positioned to be the catalysts to make sure that the things that are going to help solve food security and promote health are being done in coherent and interconnected fashion.
• We’re not going anywhere soon, so we have stability.
• We have respect to broker partnerships and coalitions.
• We also have detailed knowledge of the range of programs in our service area and through our existing agency reporting we have some crude idea of the outputs of service.
• More than anything, we have the food. That has always been our ace card, but we’ve never really played it as hard as we could. We really need to leverage every pound of food we distribute to effect lasting change.
This is all based around evolving the role of food within the organization. It is still central (relax…), but now it is not the end in itself. We are not only the food sourcers, storers and distributors – we are the food investors. We are going to leverage every nutritionally dense pound of food to bring significant long-term impact to the good health of our service area.
The price of doing business in the leverage is to provide good service to those who will always need food assistance as a result of challenges of age or faculty – yet even these folks can benefit from involvement in holistic service. Nevertheless, I am putting them lovingly to one side and saying that we will always find a way to source the food needed for these folks.
That leaves people whose lives we can impact significantly – children, families, those with chronic health conditions, those who question their limited voice or power in the community, those who want to share the skills required for good nutritional health with others in their neighborhood.
Being a catalyst sounds easier than doing everything yourself, but really it is just a different kind of difficult.
The below graphic shows the resources that we are providing in our area to stimulate effective nonprofit agency responses to local nutritional health issues:
If we have a traditional org structure then provision of the above services is going to look like the many-headed hydra. It also means that it is only a matter of time before one head or other gets lopped off, because it is not sustainable.
Let’s look at an alternate structure. Enter, if you will, through the doors of perception…
The doorway is a good metaphor, because people, food and resources can pass through it in both directions. So imagine your Foodbank in the center of the community (because it’s hard to escape from our self-obsessions) and further imagine four doors around you that lead in from and out to that wider community.
I am suggesting that this kind of restructure requires you to shift how you do business to facilitate the most efficient methods of stimulating two-way traffic through these doors. It means you have to inspire and join with and prod and poke your partners in the community (starting / but not ending with your member agencies) into embracing impact and sustainability and rigorous evaluation of their activities. And if you the food bank are going to initiate something new, you need to find a way to make it sustainable long term which means planning from the start of the process how the community will have assumed ownership of the project by the time it reaches maturity.
The four doors are:
1. Partner Organizations
2. Food Bank Programs
4. Community Leadership/Volunteers
Let’s look individually at each of these ‘portals’ for food, energy, time and collective will:
Partner Organization Doorway
This is always going to be the biggest door. If we’re going to maximize our impact we need vibrant relationships with other nonprofit organizations. Yet we need to shake things up a lot in terms of how our current partnerships work.
We are already monitoring member agencies, but because our focus has been about ‘maxing’ poundage, we have not pushed/encouraged agencies to embrace a ‘shorten the line’ agenda. Agency segmentation has been helpful for us in seeing who can be the best partners for ‘shorten the line’ services, but at some point, tough decisions need to be made about what relationships need to be prioritized for the good of the community.
We are in a time when traditional donated food supplies are tight and we are all working hard to find the next ‘wave’ of available product. Consequently this is the perfect time to make every pound count and leverage existing relationships by expecting more of our partners that turning our inventory for us.
If the relationship with community partners is to become more about impact and not just poundage, then you might find yourself with a different set of partners. Some of our most successful new partnerships are not based around agencies distributing food for us. We are working with American Heart Association, who are providing some educational components to our existing educational structure with our Kid’s Farmers Market Program.
We also are working with a local ‘cradle to career’ school initiative called Thrive, where our educational programs are helping them meet funding-mandated nutrition education requirements. We are in discussion with other potential partners around working together in community building and in food systems reform.
Our educational programs typically include a distribution element, yet in at least half of them, this is really a micro distribution compared to the ‘here’s 20lbs of broccoli, good luck with your life’ approach of the past. You might feel that this is mission drift, but I know that each one of these partnerships will have more long-term impact on increasing food security then setting up another mobile pantry.
Your existing agency relations structure may not be able to work with this expanded set of partners. For us there is already a challenge in how to work with two different types of partner within our existing agency structure. We need to do more to reconcile these types of partnership, so that the ‘non-food distributing’ partner does not become the poor relation (or vice versa). Close links between agency/partner relations and the work of the development and program departments now becomes crucial. The old siloed approach to information of the past can be disastrous in this kind of relationship.
FOODBANK PROGRAM DOORWAY
We are increasingly looking at pushing out our award-winning ‘Feed the Future’ children’s programs through our member agencies as a way of bringing them to scale and thereby meet our vision objectives. The programs are run by ‘super-volunteers’ and therefore are sustainable. Tapping into other agency’s ‘super-volunteers’ will enable this sustainable scale to increase. This represents another big element of the catalyst relationship – we can develop and evaluate programs and then our agencies and partners become the natural conduit for scaling these programs.
We need to make these programs (which all include both ‘feed the line’ and ‘shorten the line’ elements) so attractive in terms of curriculum, training and food availability and so effective that agencies will want to run the programs. Do agencies pay a license fee? Do we give them away? Do we ask them to provide some shared maintenance for the food element? For us, these issues are still to be decided.
We’re not big brother, but if they want to run a different program that is fine, as long as the evaluation and data connected to their program are broadly comparable so we know they are getting the impact.
A food bank running programs and fundraising to deliver them is not really sustainable in the long-term. Yes, you can always find a donor to pay for one nutrition ed program or another, but unless you have found a way to let the community take ownership of the program long-term, it will eventually languish. Which leads us to who should be running the programs.
COMMUNITY LEADERSHIP / VOLUNTEER DOORWAY
I believe the closeness of the relationship of volunteers to non-profit organizations is cyclical. At one end of the cycle, the focus is on an all-paid workforce with an overlay of marginalized volunteers to manual tasks or food sorting or packing. This can lead to disconnection from a large part community – especially professional people who have a lot of other skills to offer. One way of telling whether your use of volunteers is truly able to help you build impact is to imagine if all your volunteers fell away – could you continue fairly easily with your mission? If so then volunteers are really window-dressing for you.
At the other end of the continuum is more of a volunteer-driven organization. Aiming to become this is a major element of the ‘catalyst’ approach for us. We have a special category of volunteer, called a ‘community leader’ who is a super-volunteer that is treated pretty much as a paid employee would be. They are typically there to focus on a particular project, but others may have long-term loyalty to a specific program.
These community leaders are paid – just not with money. This ‘payment’ might be with the provision of written references, or with respect, or with being given leadership responsibilities. These Community Leaders are held to account for what they have committed to do and reassigned or fired if they do not produce. This has helped us scale our programs significantly.
I can’t pretend this has not lead to cultural strains within the organization, which naturally wants to shift back to just having paid staff. Employees find it easier to lead people who are getting paid to listen to them, rather than having to go to the effort of inspiring volunteers will listen if we communicate effectively the power of our mission and the direct impact that volunteer can have on moving it forward.
We are making significant progress, though. I think there is something empowering for our employees in letting them know that they are all expected to be leaders of multiple volunteers, no matter what their job function is. It is all about multiplying their ability to achieve impact. Yes, we all know it feels so much easier to do something yourself rather than explain to someone else, but that is not sustainable.
The changes that this means to a traditional food bank structure is that you need a lot more ‘relationship manager’ type staff – they might be handling relationships with community leaders, short-term knowledge philanthropists that are working on a specific project, or outside organizations that we are partnering with. These are all people who need more attention / coaching/ focus than just the usual volunteer management skills. You are managing outside talent and it takes tact, organization and a clear understanding of the shared goals. We don’t really have the experience or skills in this area (besides in the fundraising arena) so it is learning a new skill and introducing a new culture, but the expectation is that staff will be managing an increasing number of community resources and so multiplying their impact as an employee.
As regards impact on the warehouse staff, if you have a rash of small scale educational programs that might require small poundage of high-quality produce or purchased items that are needed to demo a curriculum-specified recipe, these can be extremely difficult for current warehouse structures to deal with. Online ordering by programs staff becomes vital. Skills at staging and coordinating multiple micro distributions have to be developed. Drivers are overwhelmed by the number and complexity of deliveries and pick ups of programmatic materials from sites. In this situation it becomes increasingly important for volunteer drivers with loyalty to specific programs or sites to become involved.
The other side of the community leadership equation for us is the way we can erase the dividing line between ‘benefactors and beneficiaries.’ Our Nutrition Advocates come out of our programs and are encouraged to work more closely with both the Foodbank and become self-supporting groups. They are trained in food literacy, can be SNAP advocates and we also provide community organizing facilitation to help organize around any local health and community issues.
Community Leaders and Nutrition Advocates represent two powerful and brand new volunteer forces that are having a major impact in how our organization develops.
THE DEVELOPMENT DOOR
These other doorways suddenly open up a lot of other opportunities for the development department. We have community leaders teaching in programs and having direct access to working with clients so we are building the kind of long-term support from motivated professional people that no number of trips to the warehouse can generate.
The mantra in food banking has always been ‘once they go to the warehouse, they get it.’ This is true in terms of comprehending the size of our operations and the fact that we are not a glorified food pantry. However, if you really want to build long-term loyalty, you need to not show them the ‘tool,’ but involve them in what the tool has built. That means involvement in direct service with clients. The old hunger dynamic made this an awkward situation for all concerned. Now that our focus is about health, this is a way that benefactor and beneficiary can communicate as equals – we all care about being healthy, we all have ideas about how good nutrition can help with this. Teaching once a month in one of our programs is a golden way of building a whole new levels of ‘getting it.’
I used to get jealous about ‘Habitat for Humanity’ and their ability to involve supporters directly in their efforts by helping build a house and leaving them with the tangible results of what they have wrought. Community involvement with our programs now brings us ever closer to this model.
The desire to take more leadership in the health arena with local partners is also creating brand new funding opportunities with foundations, businesses and individual major givers who are looking for long term social solutions not short term charitable fixes.
One size does not fit all, and I am not suggesting that your organization should focus on the catalyst approach, like we are. Nevertheless, I would challenge you to look at your mission and how it has changed and then start asking the tough questions around organizational structure, so that you can be ready to meet the challenges of the next twenty years as we work to achieve the long-term health and food security of our communities.
NOTE TO ‘FROM HUNGER TO HEALTH’ READERS:
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If you want to be a big celery-waving food bank then it is all about increasing your poundage, or should I say increasing what is the new guise of poundage – numbers of meals. (Even though by current reckoning, meals can be comprised of things like pounds of candy).
Nevertheless, assuming that you are doing your best to distribute pounds of nutrient dense food, surely providing more and more food to the community has to be a good thing right? Absolutely.
But is it also an effective measure of the success of food banks at ending hunger?
Not necessarily, because this apparent success is also a strong indicator of the continuation (some might say institutionalization) of food insecurity in America. If we’re giving out more and more food, we are not shortening the line of people who need our services and so failing to bring lasting food security.
If times are tight for people and free food is available, then any smart person is going to take as much free food as they can get their hands on, providing that the distribution timing or environment aren’t so difficult as to make it not worth their while. People will then divert the funds they had for food to pay for some other expense for which there is not so much freely available help. It is the smart thing to do, and to be food insecure in America, you have to learn to be smart pretty quickly.
We like to give food to anyone who says they need it without much in the way of preconditions. And who doesn’t need food? Your stated mission might be to ‘ameliorate hunger’ or ‘end hunger’ or if you are windy Californians like us then you might want to ‘end hunger and transform the health of Santa Barbara County through good nutrition’. Whatever your goal, we need a way of finding out whether we are succeeding at doing more than keeping the nutritional health of millions of Americans tethered to our life support machine.
Which is where evaluation rears its head.
Food banks are still better at demonstrating outputs (pounds, meals, people served) rather than outcomes (individual behavior changes, community change and societal change). Time was we could get on our high horses and proclaim that ‘ensuring a child didn’t go to bed hungry’ was an outcome as far as we were concerned and the most import one – oh, and by the way, how dare you even ask us to justify what we are doing.
Those days are over.
Whether you buy into the whole ‘nutrition bank’ thing or not, you are will still be noticing a gradual shift in how food banks are being perceived by larger foundations. A few years of recession were good for automatic and generous funding. Even now, knocking on the foundation door generally assures us of having our request for operational funding awarded at x dollars, because ‘everyone loves the food bank.’ However, the social service organizations who are winning the award of x plus x dollars are the ones who can successfully evaluate what they are doing and demonstrate impacts in the community. And sorry, that’s typically not the food bank’s grant application.
As a Mr. Potter-like CEO, I don’t like to leave money on the table, and I believe that there is a huge pile of money sitting on the table for food banks that we are currently not able to pick up more than a few scraps of – health dollars.
The Holy Grail for a food bank like ours would be the ability to demonstrate and quantify the contribution of our programs to lowering levels of childhood obesity, diabetes, food-related cancers etc. If we could do this, we would be in a strong position to be better funded with private and federal health dollars.
I want those dollars to continue the little nutrition revolution in our service area and I want them for you too, dear reader.
Despite the importance of exercise, it is clear that when it comes to the most effective and cost-effective way of maintaining good health, ‘it’s the food, stupid.’ Food is what food banks have and it offers us the potential to make an incredible contribution to the wellness of this country.
It is my belief that in the food bank network, we are sitting on the most powerful, most cost-effective preventative healthcare machine the country has ever seen. We just need to be able to unleash its power.
The way to do that is not to collect a few dollars to feed the needy, but to collect serious bucks to keep the nation healthy. By a combination of nourishment, education and empowerment, we can move millions of people – not just out of hunger, but out of hunger and into health.
Now, to kick me off my high-horse and to get us those health dollars, it takes evidence. And that takes evaluation.
This is where Serena Fuller PhD, the Foodbank of Santa Barbara County’s Health Education and Evaluation Manager comes in. Serena is a Registered Dietician with a background in obesity research (yes, lab mice are her friends) and public health. She has been on staff for about a year and a half now. When she was brought on board, the understanding was that part of her work would be to find this Holy Grail for us and deliver it to the development department so they could ride out and return with the gold.
Good scientist that she is, she had no interest in fudging the figures or finding some woolly way of claiming direct medical benefits from our programs that we cannot really prove.
Getting over this disappointment, we moved on to a phase of having her dirty her nice white lab coat with the realities of food bank programs and for her to be involved in the creation of new programs. We also began to consider different evaluation options.
Have we found the Holy Grail? Of course not – it’s all about the quest, dude – but we did find what we believe is an important next step for us, which can also be replicated at other food banks.
It comes down to working with public health evaluation measures as opposed to medical evaluation measures.
We are now in the initial stages of piloting an evaluation approach based on the RE-AIM framework championed by Russell Glasgow. RE-AIM is an acronym for Reach, Effectiveness, Adoption, Implementation, and Maintenance and is an evaluation framework for public health type activities.
So why don’t medical measures work for food banks? Let’s get a teenie bit technical for a minute and look at the classic medical measures. (Take your motion discomfort pill if necessary)
Agencies often brag about ‘collecting BMI’ hoping that this covers a multitude of other evaluation sins. BMI is really just an indicator of later health outcomes, not what we are doing over the short term. Currently there is some question about whether BMI really is measuring what it is supposed to measure – total fat mass. It remains in use as a measure because of some clear positives: 1) it’s relatively easy to collect 2) it’s non-invasive and 3) it seems to correlate reasonably well with fat mass. Essentially some scientists have called into question whether it is good at telling whether people are actually healthy or not.
While total cholesterol, LDL and HDL cholesterol are measures for risk of heart disease that doesn’t necessarily equal myocardial infarction i.e. heart attack. Cholesterol levels have also been critiqued in the literature as not being a sensitive or specific enough measure and thus have a low(ish) predictor value. But, just as with BMI it has positives as regards ease and non-invasiveness and it seems to correlate reasonably well with risk of heart disease.
WHY FOODBANKS SHOULD NOT BE COLLECTING MEDICAL DATA
The measures discussed, especially BMI, don’t change much in the short term, which is when these labor intensive measures are typically collected (expect in instances of multi-million dollar, long term, multi-clinic studies). Based on her experience at the Foodbank, Serena formed the belief that food banks should not be in the business of measuring subject-level ‘medical’ data because of invasiveness, the cost associated with this type of data collection and because of the issues raised above with regard to commonly collected medical measures. All this meant (in her favorite phrase) that ‘the juice was not worth the squeeze.’
The take away from all of this is that food banks can find their own measures of health, that are reasonable to collect, measures that can change in shorter amounts of time and which – just as much as with ‘medical’ measures – correlate reasonably well with the true health outcomes that interest us – long-term decreases in rates of morbidity (disease) and mortality. Being hungry sucks, but being grossly unhealthy or dead really suck.
These measures that we are most interested in are ones that score diet quality and food security scores.
Medical studies typically focus on populations that need to be similar in order for the data to make sense. But food bank populations are incredibly diverse and it would be unethical to exclude clients from the study if they needed food and their diversity doesn’t bode well for showing statistically significant changes in anthropometric, clinical and biochemical measures.
There is certainly the place for a few well-funded food bank research studies at a national level* (Check suggestions for these out at end of the post).
You may remember a post last year on ‘From Hunger to Health’ where I interviewed Dr. Hilary Seligman of UCSF, who was involved in looking at food security and how it can make major improvements in people with diabetes. There is also the Bristol-Myers Squibb project with Feeding America. It was discussions with Hilary which began to move us down the pathway that led to the RE-AIM tool.
Because we want to run programs with the goal of improving the health of our community, we needed to find an evaluation framework that could capture changes in health.
RE-AIM has been used nationally to assess a broad range of community health interventions from actions to prevent child abuse through evaluating the efficacy of specific exercise programs for the elderly. A list of documents and links demonstrating some of these is contained at the end of this post.Here is a link to a monograph on using RE-AIM for program evaluation RE-AIM_issue_brief.
RE-AIM is unusual in that it moves beyond the current approach taken by the medical community to assess community-based interventions. In medical terms, the gold-standard is the Randomized Clinical Trial. In this, there is a focus on something called internal validity, which brings with it a tendency to oversimplify issues and their outcomes in order to isolate the impact of the program. Food banks don’t operate in a bubble. In particular, the emphasis on eliminating the potential for confounding factors typically results in samples of very homogeneous, highly motivated, healthy individuals which equates to samples of non-representative people.
RE-AIM hypothesizes that the overall social-change impact of an intervention is a function of all five RE-AIM dimensions not simply the client-based outcomes. The implication is that to have a substantial impact at the population level, an intervention must do reasonably well on all or most RE-AIM dimensions and thus all 5 must be evaluated or measured.
Our Foodbank RE-AIM evaluation allows summary indices which we have termed ‘Success Scores’ which determine the overall impact of individual programs as well as initiative areas. We realize that the process will be iterative as we develop more measures with high reliability (measures the same thing over time) and validity (actually measures what you think you are measuring) and which include more stakeholders.
Our Success Scores have a range of 50 points, so as to be reasonably sensitive to the different activities we are doing right or areas that need improvement. However, we may find over time that 50 points isn’t sensitive enough or is overly sensitive and we so we will change the Success Score. That is the beauty and strength of evaluation over research in a community setting conducting translational work in that it is more flexible and dynamic.
Here is a link to an excel file that shows how we set the RE-AIM measures for a number of our programs.Program Score Card
Looking to the future the E part of RE-AIM (the effect) and the M part (maintenance) allow an organization to measure the ‘medical’ outputs if resources and will permit.
We are focusing initially on diet quality and food security because just like BMI and cholesterol levels they are reasonably well correlated with our outcomes of interest – adverse health events, long-term morbidity (disease) and mortality (death). Plus if we are improving the food security status of our clients, the idea is that the demand for food bank services, in the traditional sense, will diminish and we will shorten the line.
We utilize well -accepted measurement tools for assessing good diet and food security:
To measure food security means that food banks will need to change their model to a model like our Healthy School Pantry or similar approach with wrap-round services like Fresh Place. Here are programs where people can get involved, become food literate, get enrolled in benefits, build their social assets i.e. meeting new people at the pantry, grow their own food, learn how to stretch their food dollar. This means we can track people who will still attend but move out of food insecurity.
The benefits of RE-AIM are that it can be customized to each individual food bank, community and stakeholders, is broadly focused with good external validity, assesses system-wide changes as well as individual changes, includes a maintenance component of making the program sustainable, which is vital when you looking at population-based changes in health status and food security.
RE-AIM can be undertaken by food bank staff and volunteers and doesn’t require highly trained individuals to collect the data, depending on what measures for E and M you have decided on.
The negatives are that there is still lots of data to be warehoused and collected, and that it can be cumbersome to gather the community input. The summary indices are only as good as your inputted data, and some sophistication is required in developing your measurement tools.
One example of how RE-AIM can help you monitor and make changes to what you are doing. Say you are running a distribution and conducting health education at the site. This health education is led by a trained volunteer and you collect your survey data from participants and see that you have no effective outcomes, (i.e. no changes in healthy food behaviors, self-efficacy, knowledge etc). If you were not evaluating the implementation you might just scrap the program, but utilizing the RE-AIM tool would help you notice the difference between this site and another site that had a translator. So the impact is really Impact = implementation x effect. The great part of evaluating implementation is you can learn which sites are doing great, learn from those sites and then take what you learned to other lesser performing sites.
We see the next stage as working to improve the measurement tools as well as identifying the best indicators, i.e. the measures the have the best predictive value of health impact, and tapping into the right partners so we that we can strategically collect ‘medical measures’. We want to develop an evidence library that supports food security and diet quality as the best predictors of morbidity (disease) and mortality (death) in light of community constraints, food bank constraints, invasiveness for subjects and related issues.
We believe that food banks could use RE-AIM to collect meaningful data about their impact on the health and wellness of their communities. We are developing the measurement tools, score cards and success scores, plus causal pathways and definitions.
If we all adopt this method I think we can have a large influence on what funders will expect and of what all of our respective communities view as our work. This is turn can show the true impact of our work. If we come together to say that diet quality and food insecurity are the right measures, especially when assessed in the context of RE-AIM based framework we will go very far in proving our impact from that of an earlier measure like Pounds Per Person In Poverty.
We need your input your comments on your systems, your criticisms – and yes, your dollars for continued development of a system that can bring considerable evalutory (did I just come up with a Palin-style coinage there?) benefit for the whole network. You can contact Serena at firstname.lastname@example.org with ideas and me at email@example.com with support!
* OPPORTUNITY FOR NATIONAL STUDIES – There is certainly the place for a few well-funded food bank research studies which would be at a national level* – looking at BMI, adiposity (via BIA or caliper), HTN, cholesterol levels, long term blood glucose regulation, e.g HBA1C (which is different than evaluation), plus diet quality and changes in food security.
In the first of an occasional look at how issues of poverty affect our ability to move people from hunger into health, I consider the Bridges Out of Poverty model in an interview with Debora McDermed who teaches and facilitates the ‘Bridges’ work being done through the Northern Nevada Food Bank in Reno. What use is Bridges to us? How does it work? Does it function best as a simple set of language tools or as a community-wide effort? Does this bridge lead us somewhere or is it really just a culturally insensitive set of labels which only helps further stigmatize people? Read on and find out…
First, apologies for the hiatus. This blog took a break for the last couple of months of 2013, partially because it is the crazy season for food banks. The other reason is that this isn’t a blog that features my knee-jerk reactions to the burning issues of the day like gun control (for that go here), but rather a blog with an educational focus on meaty subjects of current concern in the ‘Health into Hunger’ sphere.
In our world we love the ‘F’ word (food); there are even fans of calling people the ‘N’ word (needy) – but whatever you do, don’t mention the ‘P’ word (poverty).
I have been in rooms with dedicated, caring management teams from food banks, where mentioning fighting poverty is like waving a silver cross in front of a vampire. The fear level about this issue is huge: ‘that’s not our concern…it’s mission drift…our donors would hate it…let’s just stick to being the good guys saving the day with the big trucks of food.’
This trepidation extends beyond the food bank world. You can see it in the messaging of an organization like ‘Share Our Strength’ that is focusing on child hunger, with the mantra that ‘we may not be able to tackle poverty, but we can at least make sure that no kid goes hungry.’
My own viewpoint is that food banks cannot escape facing up to wider issues of poverty and how they impact our work. Unless we’re in this just to have long-term job security and to look good at Christmas, then we have to say we have had enough of the current status quo – a national state of rampant malnutrition which continues to weaken the health of our communities. That means we are going to have to deal with poverty to some degree or other.
Most service providers would acknowledge that they have to not only ‘feed the line’ but to do something to ‘shorten the line,’ yet addressing poverty rarely figures in these plans. You would think that poverty is the most tangible thing in the world – you can see it and smell it and touch it – yet when we want to do something about it then it becomes some nebulous mist that seems to slip away from the grasp.
There seems little shared agreement about either its causes and its cures. Consequently it joins the increasing number of subjects – such as immigration and gun control that become too uncomfortable to talk about – and therefore must be placed in some ‘no go zone’ of polite national discourse.
How does Bridges Out of Poverty enter into this discussion? It is a series of training modules designed for individuals in poverty (the ‘Getting Ahead’ course) and for communities or organizations (Bridges Strategy and Applying Concepts courses) that seek to create a framework of common understanding about why people get trapped in poverty and which offers some ways in which both individuals and their communities can move out of poverty.
Now, of course, when you have such a wide-reaching set of social concepts arising from a single person (and one presenting very modest research or epidemiological evidence, and whose trainings are sold through copyrighted trainings and books) two things are going to happen:
1. The academic community will go ape shit in their desire to expose and condemn this heretic who has dared skip the years of longitudinal studies and research to say a lot of things which in the end are only backed up by their belief in their own experience and intuition, rather than in a long history of published research. And there are certainly Bridges opponents out there. Here’s a good broadside. Bridges would argue that a lot of these critiques typically focus only on the framework and not how the framework is actually used and adapted within communities.
2. He/She who is condemned for their theories will also collect adherents– people looking for simple solutions to complex problems. These supporters will say that you need to charge ahead with what your gut tells you and not wait for some kind of historical validation, especially with such a pressing concern as poverty.
So, where does that leave the rest of us? We are not academic snobs but we also want to be sure that a new approach follows the doctor’s oath of ‘Primum no nocere’ or ‘First, do no harm’ and ensure that this will not make the situation worse.
I did some research into the Bridges work and met with Food Bank of Northern Nevada CEO, Cherie Jamason (who has spearheaded the uptake of Bridges in Reno) and Debora McDermed of The Vertical Dimension Consulting who runs the programs. Subsequently I invited Debora to present a workshop on Bridges at our annual Agency Leaders Summit.
Her presentation was a huge hit and seemed to touch a nerve with a lot of people from agencies who felt that this work was communicating something that they had believed at some level but never been able to put into words about the challenges they faced with their clients and that it offered some interesting tools for them to try on.
There’s a two-hour presentation, which is an overview. That’s ideal for CEO’s or business people who just want to get the gist. They don’t necessarily want to come to the training. Then, there is a two-day training. The first day considers what is Bridges and what does it mean and why would you be interested in it? How could you immediately put it to use? Day two looks at the tools and the techniques. The two-day version is designed primarily for service providers who want to interact with the client differently or they want to try some new program designs. This training can also be done from an institutional or community point of view. We have run courses for the healthcare, educational and judicial communities. How can these ideas help you be more effective with the client group you are working with. (Here is the flyer from a recent Bridges training conducted by Santa Cruz Food Bank) Bridges Out of Poverty 2012 Flyer
‘Getting Ahead’ is an intense program for participants who want to transition out of poverty. They meet for about two hours a week or somewhere between 10 and 16 weeks depending on the group. They learn the same thing that Bridges trainers learned in the two-day course, except they’re investigating it much more thoroughly. They look at how does poverty occur for them and their family. What are the societal influences in poverty? What are their personal individual influences? It’s really very rigorous.
As to community, once a number of trainings have taken place with different groups, often someone will say: “We need this in a big way for what we’re trying to do.” And so then the program can have a wider community focus. That’s what happened in Reno.
I think Bridges is a long-term vision but it has some short-term gratification. BridgesModel_HardDifferentiators You’re not going to end the poverty in five years. But there is something you can do immediately which I think gives people on the ground tools and techniques and ideas to implement. The training answers a lot of questions that people have never been able to find answers to around why it is so hard to help people make behavior change. I think people are invigorated by that. Poverty is defined by a lack of resources, and the USA is a country that is has severe income disparity as defined by the GINI index. Countries with this great disparity have real problems with upward mobility, hence the need for approaches like Bridges.
You mentioned about changing people’s behavior. How much of this change has to be down to the individual, and how much does the community or society have to change? Where is the line?
These are hard questions.
Sorry. This is such a thorny area, there aren’t many easy questions.
Individual change begins to happen because the program that we facilitate for people who want to transition out of poverty gives them a voice. It’s not a program that’s designed for them. It’s a program that they designed to build their own resources. That creates more ownership, more autonomy, more buy-in. Systemic change is obviously harder. It looks at the way we organize bureaucratic and administrative things to see if it actually enhances people’s ability to take responsibility or if we’re actually putting processes in place that continue to keep them stuck. The community pieces of our program identifies what the barriers are in each community – and they’re going to be different. Some communities have great public transportation. Some have none.
What barriers do we as a community need to tackle that would prevent people moving to sustainability over a period of 18 to 24 months. Can they get a job? Can they get transportation? Can they get childcare? Can they get on their feet in that period of time? Or is the community set up such that it will take much longer than this. This process shows what the individual needs to change and what the community needs to change to be able to facilitate this.
What about the blame game? Some want to heap all the blame on the individual and some want to heap it all on society. Can Bridges help with this?
I think so, because this training goes down well with those on both the political right and the left. The right likes it because it makes people accountable. The left likes it because it says it’s not all their fault and we need to make changes to bring mobility back to the United States so that people can move from their economic strata like they once could. It’s a very current, hot conversation when I’m talking to those people because I can talk about rebuilding the middle class. But I should stress that Bridges is not about making people ‘middle class,’ it is about people being able to create stability and build resources. And Bridges isn’t a program brought in from the outside, but a set of ideas. This is why Bridges and Getting Ahead are being used in Australia, Canada, Slovakia, Czech Republic etc and Detroit, Pensacola, Menominee Nation, Appalachia, etc.
Let’s talk in more detail about how the ‘Getting Ahead’ program works.
The first thing participants do is they draw a mental model of what their life looks like right now. (We have them draw because we don’t want to inhibit anyone who doesn’t read or write well.) Then, they identify those factors in their life that are affecting them dramatically. If they’re a single parent; if they are recovering or not yet recovering from substance abuse; are they dealing with the judicial system? These mental models help them build rapport with the facilitator. We call the person who teaches the course the ‘co-investigator.’ It’s not a hierarchical model.
We sit at the table with them and say we’re going to investigate the situation, your life and the situation in the community and see what is possible. They start with their own life. The theory of change that Bridges uses says that when you are in poverty, you are in the concrete virtually all the time. We call that the ‘tyranny of the moment.’ Therefore, this makes it much harder to do the abstract thinking which is where all of your planning, and many of your good decisions come from. This might include thinking such as If I spend this money on a plasma TV, I can’t go to the dentist. People in poverty, particularly generational poverty may have never learned how to do abstract thinking. We teach them how you can live in the concrete and think in the abstract. This helps them begin to step back and look at their life and analyze what’s going on and what to do about it. That’s very powerful for people. It’s also very painful. I had one person say, after they looked at their mental model, they said, “Wow, poverty really sucks.” But they were so busy just trying to eat, have shelter, some kind of job that they didn’t really have time to step back and look at it and go, “What new possibilities could I generate?”
Then, they have a lot of environmental influences like family members and neighbors who are all in the same boat who might live in ‘invisible communities,’ so they don’t know any people who could provide a different kind of help and assistance. Over a series of time, they also investigate societal change and influences. What are the societal influences that have kept people in poverty? What are the hidden rules of class? What does the middle class know that I don’t know? If I knew that, would I behave differently?
We do a lot of work in language skills, because they might habitually speak in what is called ‘casual register’ which is all about relationships and survival. It doesn’t work very well for job interviews or with a judge, or your kid’s teacher, where ‘formal register’ will be more effective. People can get marginalized because they might seem to speak disrespectfully or inappropriately. They start to learn about all the things they need to do to be able to cross this bridge. The course we run is not the end. When they graduate from it, they’ve developed a list of resources both personal and community that can help them move forward. They can’t magically change everything at once so they might decide to work on finance or emotional health.
Then, we encourage a community structure that is there to assist you when you have finished the ‘Getting Ahead’ program. Graduates are invited to meet monthly with allies, people that are wanting to understand how to make this a better community for all. We don’t call them mentors. We don’t call them coaches. We call them allies. This meeting is monthly and it is a partly social, partly educational gathering. Graduates can stay in it for 18 to 24 months past the course. They start to lead those sessions over time. They start to talk about their experiences and share with other people that are trying to transition. So, we build a network for them which can take them to the next level. They don’t have to join if they don’t want to. It’s available to them. So far, we haven’t had anybody not want to do it.
Poverty can be a lifelong challenge. For instance, one of the people who came up to me after your agency workshop who has a job and is living in a $2100 a month condo – which I guess is not hard to do in Santa Barbara. He came from poverty, raised in poverty, and even though he is now out of poverty, he said to me, “I’m haunted everyday of my life that I’m going to end up back there.” What comes out of the wider community support is that people start to get to know each other. They start to understand that people in poverty are just like them. Then, they began to form alliances, when people know somebody who has a job going, and they now have someone to call. That’s social capital. We do it all the time. People in poverty don’t have that. The only kind of capital they have is bonding capital with people who are typically in the same situation as they are, perhaps not making healthy choices or good decisions.
Sometimes they’ve had to separate from some of their family members as part of the process because their family may not be supportive of them in moving ahead, getting out of poverty. There are some emotional challenges that happen along the way, and that’s why we do the emotional resiliency piece within the training. When you start to change, not everybody around you likes it. This doesn’t stop people getting hopeful and positive. They know what they can do. They understand how to build and where to start. They understand how hard it’s going to be, and that we are in tough economic times but they have a place to start.
Why do you think that food banks are well-positioned to get involved in something like Bridges?
Food banks serve so many different agencies and clients in communities that they can act as ‘honest brokers’ in the communities. It is also an effective way for them to work to ‘shorten the line’ of clients. It’s also fun to work with people in a resource-based way versus a need-based way. I think we’re excited that we’re helping people build resources for sustainability. We’re not just giving them something to get through the week with.
What about the food banks that are getting very concerned about drifting from their mission or getting into an area where some of their donors or their board are going to freak out at them by being involved in issues of poverty.
A process of education is often required for the food bank board. In Reno, we happen to have a board chair who is a businessman. He doesn’t want to keep raising money to feed the same people every year. He wants to find a way to help people move out of the need for our services. The logic of it then, from a bottom line point of view can be very appealing. It also involves being a leader in the community in a new way.
It is also be a way of making a difference in a measurable way quite quickly. We can count the number of people we’re educating. We can count the number of people graduating our ‘Getting Ahead’ program. We can count what happens to our graduates as they begin to move on. it’s a win-win. You can lower your food procurement dollars, and you can increase sustainability in the community.
I will tell you on that the fundraising side, the funders for our Bridges work are not people that were funding the food bank before. We’re finding a lot of new funders who are interested in capacity building. They were not interested in needs-based money. There’s been no adulteration of the food bank dollars. In some cases, the same people who donate to the food bank now also give to Bridges. Like Wells Fargo Bank and Charles Schwab. They say, “Yes, we’ll still continue to give for a food distribution program, but we’re also really interested in what happens to these people in the community as they began to grow.”
I believe in a previous conversation you talked about the ‘hidden rules’ about food distribution. Would you to clarify what you mean about that?
With people in poverty, their view of food is all about scarcity and ‘having enough’. People will hoard food. They will take more than they need. This is because of scarcity being the primary focus. It doesn’t have to be good food or be cooked well. It doesn’t have to be nourishing or healthy. But there has to be enough of it. In middle class norms, people may care more about how things taste and look. With food distribution programs, those running them often care most about fairness. So you can see how these two things are going to rub up against each other, because both groups are not necessarily able to compensate for the other’s perspective.
If we have a situation where someone takes more than their allocation, then there is a breakdown in the relationship. There is agitation from the volunteer around fairness and agitation from the client around scarcity. I did a volunteers training at the Reno Food Bank. They were having these type of problems and the volunteers were pretty cranky! After they had the training, they tried some new things that they came up with on their own. There was a much better result meaning people didn’t hoard.
Give me an example of some of the things that they changed.
They changed the order in which they gave out food. People would always get there early, and they would be the same people every week. If you came later and were at the back of the line, sometimes you didn’t get anything. Now sometimes they start at the back of the line or in the middle. The second thing we did was ask the clients how they could improve the situation. The Bridges construct says that you give people in poverty a chance to be a problem-solver. You don’t solve the problem for them. The clients developed a way of trading food at the site. Somebody didn’t want bread. Somebody else wanted two cans of tuna fish, whatever. They figured it out themselves. They were happy with the result. The food bank distribution people were shocked. That’s what happened. There was a little lessening of control, but it worked to everyone’s benefit.
Deb, thanks for sharing some of your work.
To move forward the Bridges work, Santa Barbara County Foodbank will be holding a two-day training with member agencies in the first half of this year. We will also look at pairing it with a cultural awareness training component. The Bridges concept of living in the ‘tyranny of the moment’ is fascinating (because we’ve all at least vacationed there…) and so are some of the observations about poverty class vs. middle class thinking in certain areas.
There are so many great things about Bridges. But what of the current challenges I see with Bridges? I would put them in two areas. The first is the ‘class’ labeling that is used extensively, with the intention of moving people from one class outlook to another. I could see that it might be hard to avoid people feeling inferior. There are the potential dangers of what is called ‘classism’, which is prejudice or discrimination based on social class.
I was brought up in England which had its own obsession with class, which was very clear and on the surface. People opened their mouths and you knew what the deal was. In America, it is more subtle. Money can reveal, but money can also obscure.
I do find the Bridges focus on making everyone middle class a little challenging sometimes as if the middle class has all the answers. I mean if the middle class is so smart why does it seem to be steadily being annihilated through financial genocide…just a thought, folks!
I think Bridges advocates might respond that it is more a process of getting people to look at how the world is working now, to look under the hood at the engine and get a new understanding that will benefit them as they make changes that they feel the need to.
The other challenge is culture. Currently, from the small amount I have seen, the program is not very well culturally attenuated. So, within the Latino community for instance, there are many very powerful tools and relationships that help people get by in life through mutual and extended family and community support. A lot of ‘middle class white’ families might give up some of their advantages for grandma living next door to watch the kids. (I know I would!)
There is also more solidity around community development and small scale inter-community investment, both with cash and sweat equity. I have no doubt that as the Bridges program develops further within Latino communities that it will be adapted to better suit a different cultural reality, and that some elements can be accepted and others rejected.
In an upcoming post, we will look at non-profit community development and empowerment programs that use different models – such as the Just Communities program here in Santa Barbara County.
This is an exciting field, because we are getting away from a fixation on scarcity which seems to breed more scarcity, and we are empowering people to generate more. I know I sound like some kind of infomercial dude telling you to ‘generate abundance.’ Or maybe I am. Give me a better tan and a toupee and I would be glad to shill for ‘generating sufficiency’ and ‘generating sustainability.’
I encourage you to investigate the Bridges approach. It is an imperfect tool, but one that is being developed and improved in communities across the country. There is no ‘silver bullet’ (just like with gun control, as Joe Biden said – he does know how to say just the wrong thing at the wrong time, doesn’t he!) At the very least Bridges is an interesting filter for individuals,organizations and agencies to look at the world through and ask: “Does this do anything to help me see more clearly? Or “Can I combine this with some other initiative to provide a culturally and community appropriate set of tools and pathways out of poverty and into a healthy, sustainable community?”
If you were an old timer like me who came of age in the 80’s, but were painfully hip then, you will remember how the musical group ‘Gang of Four’ put it.
Previously in these pages we have questioned whether some of what we do to help clients through our distributions and programs might actually be having a negative effect on the long term health and independence of those clients. Earlier this year I interviewed Jan Poppendieck about her book Sweet Charity, which addressed some of these concerns.
The book was published last year, and this piece also draws elements from an interview with the author that took place this week.
Let’s start out with a little Rorschach test on your attitudes to our work. How does the following quote land with you?
Give once and you elicit appreciation;
Give twice and you create anticipation;
Give three times and you create expectation;
Give four times and it becomes entitlement;
Give five times and you establish dependency.
Does it piss you off? Do you default to a stance that everyone deserves enough food therefore dependency doesn’t even come into it? Or maybe you kind of agree with it. Whatever your response, I would bet that you will find a lot to chew on in Robert Lupton’s book.
“Food in our society is a chronic poverty need, not a life-threatening one. And when we respond to a chronic need as though it were a crisis, we can predict toxic results: dependency, deception, disempowerment.”
His basic supposition is that a lot of what NPOs and churches do to assist people has a negative rather than a positive result. He is not questioning people’s motivations, but rather the unintended consequences of rightly motivated efforts. He believes that if ‘emergency’ relief does not transition to development in a timely way, then compassion becomes toxic.
He provides an ‘Oath for Compassionate Service,’ which is meant to be a guide to the provision of services:
The Anatomy of Giving
Lupton describes his own experience of handing out boxes of groceries from one of his church’s food pantries. He began studying the facial expressions and the how recipients seldom gave him eye contact. The body language of the recipients was head and shoulders bent slightly forward, self-effacing smiles and meek ‘thank yous.’ He observed how quickly the response to charity devolved from gratitude to expectation to entitlement. He then observed his own part in the ‘anatomy of giving.’
“I expected gratitude in exchange for my free gifts. I actually enjoyed occupying the superior position of giver (though I covered it carefully with a façade of humility). I noted a hidden irritation at those who voiced their annoyance when free food stocks ran low. I grew weary of filtering through half-truths and manipulative ploys as I sought to equitably dispense resources.”
After 6 years of running homeless shelter kitchens I would have to agree with Bob’s observation of the attitude he observes in himself and others. He says that doing for rather than doing with those in need is the norm. Add to it the combination of pity that can become patronizing with unintended superiority and charity becomes toxic.
Big is Bad, Small is Good
Lupton spends a good chunk of his book looking at the sometimes misconceived results of church foreign aid trips, and disempowering nature of aid to Africa, but he also provides a detailed demolition job on the work of TAP (The Atlanta Project) born out of Jimmy Carter’s desire to eliminate poverty in Atlanta prior to the 1996 Olympic Games.
This top down approach to community development spent countless millions to leave behind a situation that was actually worse at the end of it. He also looks at the Faustian bargain that was the Salvation Army’s acceptance of a mega donation from the Kroc Foundation to build huge Kroc Centers that would centralize a vast array of social services. While this is convenient for the economies of scale of the service providers, it has the effect of drawing people from miles around to access the services and so distorting the normal societal fabric of the area around.
Lupton favors the Asset Based Community Development (ABCD) model (More on this in a later post) and his own organization in Atlanta operates on the smallest neighborhood by neighborhood approach. He also musters a pervasive though depressing argument about the effectiveness of microloans overseas and the reasons why they would not work in this country, except for with first generation immigrants. (He has nice things to say about ex-Feeding America CEO Vicki Escarra’s new organization, Opportunity International).
Lupton talks about ‘Parity vs Charity.’ That it is a very delicate undertaking to develop authentic parity between people of unequal power. But relationships built on reciprocal exchange (what he calls holistic compassion).
When Justice and Mercy Meet
Lupton identifies compassion as a powerful force, a stamp fo the divine nature within our spirits. It lies within us all – from tender child to hardened criminal – waiting for the right trigger to set it off. Mercy is a power that compels us to acts of compassion. He indicates that the Bible places equal emphasis on both mercy and justice. “He has shown you, O mortal, what is good. And what does the Lord require of you? To act justly and to love mercy and to walk humbly with your God.” (6:8, NIV)
He breaks this down:
– Act justly. Justice is fairness or reasonableness, especially in the way people are treated or decisions are made.
– Love mercy. Mercy is compassion, kindness or forgiveness shown especially to someone over whom a person has power.
“Twinned together these commands lead us to ‘holistic involvement’. Divorced, they become deformed. Mercy without justice degenerates into dependency and entitlement, preserving the power of the giver over the recipient. Justice without mercy is cold and impersonal, more concerned about rights than relationships. The addict needs both food and treatment. The young woman needs both a safe place to sleep and a way out of her entrapping lifestyle. Street kids need both friendship and jobs. Lupton identifies that mercy combined with justice creates:
– immediate care with a future plan
– emergency relief and responsible development
– short term intervention and long-term involvement
– heart responses and engaged minds
“Mercy is a door, an opening, an invitation to touch a life, to make a difference. But it is not a destination.”
I believe that this resounds heavily within our work in ‘emergency’ food provision. We know that the vast majority of what we are now dealing with is the chronic situation not the emergency one. It is time we owned up to the responsibilities and possibilities of what we are involved in.
What is the real ROI that we are seeking with our billions of pounds of food? Those who read this blog will know that I believe that this return is in terms of a huge impact on the preventative healthcare of our communities and by using food banks to leverage and co-lead community development efforts.
What is the way from here to there? How do we transition from emergency relief to development? We could do worse than follow the steps suggested by Roger Sandberg, Haiti Director of the NGO Medair. He describes a progression of three steps:
1. Relief – Responding to the initial need. (We’ve already achieved this).
2. Rehabilitation – This overlaps with the first stage. It is anything that increases the capacity of a local community enabling them to respond to future crises. (This would include nutrition education and empowerment programs that a food bank can run or champion, and I am sure you can suggest lots of other things at this point in the continuum.
Lupton promotes food bank-supported food cooperatives as a replacement for food pantries that ‘offer free food at the price of recipient’s dignity.’ The cooperatives he mentions in his book are run by Chad Hale of the Georgia Avenue Minestries.
This organization is a member of the Atlanta Community Food Bank. Co-op members pay $3 biweekly dues for $30 worth of groceries. (More on the pros and cons this approach in a later post – if anyone wants to share any experiences, that would be great).
3. Development – This overlaps the other stages too. Development work is long term. It seeks to raise the standard of living and the quality of life for a population over many years. (This corresponds to the work a food bank can do creating jobs, assisting with community organizing and partnering with coalitions to work on long-term change in service areas).
Lupton believes that currently, the food bank network as a whole still remains on the sidelines of these efforts. Many food banks have great untapped potential to be involved in community development, but are shying away from it for a number of reasons.
“Erik, I’m glad that this discussion is coming up. It is encouraging that an increasing number of food banks are reconsidering a more community developmental approach.”
It is not unfair to Lupton to say that he doesn’t necessarily have a lot of answers about what the role of food banks should be in fostering this community development approach. He is clearer on the negative effects of some of what we do now.
That means it is up to us to create this vision for ourselves, in collaboration with our communities and our member agencies.
There is a lot of potential for new ideas and scaling of existing ideas. These are exciting times to be a food banker.
AFTERWORD:I normally stir up the odd vociferous reaction to my posts, and these sometimes upset those on the political left and the right equally. This is usually an indication that I am on to something interesting in my waggling of tooth nerves. The latest post is no exception. People are way too polite it seems to leave stinging comments on the actual blog, but send me emails instead, which is a shame. I am happy for a little public pushback.
The reactions to the Toxic Charity entry largely indicate a concern that this is some kind of right-wing agenda to ‘blame the poor’ for their situation and to cut them off from help. I don’t see it this way at all. I see it more of a case of ditching kind but ineffectual low-touch help and replacing it with long term relationship and commitment to make change in the community (which is the best help of all).
I think it is one of those situations where when we touch a sensitive area, then everyone retreats to a defensive position, sensing criticism and judgment and thinking they hear the things they are expecting and dreading to hear. I’m the most sensitive, touchiest little soul there is, so I am just assuming that others are the same.
It may be very uncomfortable for people to deal with Lupton’s criticisms of things that are close to our hearts, but I think if you look into what he is recommending in its place: Asset Based Community Development, you will see that this is not some kind of harsh ‘fend for yourself’ approach, but involves us helping each other in a deeper, more lasting way.
As I get into this work, I find the default approaches of left and right to be increasingly unhelpful and out of touch with my experience of the world.
Some of the themes that have been bubbling up in recent posts have concerned food banks searching for ways to impact client’s lives for the longer term, and then how we might be able to measure that improved food security and self-sufficiency.
This week I am looking into the success of the Freshplace pantry in Connecticut, a collaboration between three community organizations: Foodshare, the regional food bank, the Chrysalis Center, which is a social service agency, and the Junior League of Harford, a volunteer organization. The difference between Freshplace and traditional food pantries is that Freshplace members meet with a Project Manager during their first visit, and then monthly, to discuss and set goals for becoming food secure and self-sufficient. Clients come up with their own goals that they want to work on, which are not imposed by the Project Manager. Nutrition education and a Cooking Matters course are also offered to memebers.
This program has benefitted from having an ongoing evaluation from its inception by a team from the University of Connecticut’s, Institute for Clinical and Translational Science headed up by Katie Martin PhD from the Department of Allied Health Sciences. Katie’s research background is in food security, community food security work, and food assistance programs.
Katie, tell me how you came to be involved with the Freshplace project
They had been working for a few years on the notion of a food pantry that could address some of the underlying issues of poverty that were creating the need for food. I talked to them about evaluating this program and in 2009 I joined their advisory group, strategic planning group as we were concurrently developing the program and the evaluation. Freshplace opened in July of 2010, and right from the beginning we’ve been conducting a randomized control trial of Freshplace where we recruit people from regular food pantries because we want to see how this intervention compares to these other traditional pantries. We randomized 100 into each group and have been tracking the same 200+ people for over a year now and will conclude our 18 month data collection in December.
What has the Freshplace group shown versus the control group in terms of effect on improving food security?
We’re in a very poor neighborhood in a poor city (Hartford) and half of all of the people we began the study with were experiencing significant hunger, cutting back the size of their meals or skipping meals because there isn’t enough food.
Over the year, Freshplace members were half as likely to remain in that category. We’ve seen increased food security and also increased self-sufficiency, which are both significantly higher than in the control group.
In the area of diet quality we’ve also seen significant improvement in fruit and vegetable consumption.
The one real challenge area is that we haven’t seen real declines in consumption of fat from snack and other unhealthy food. That means we still have some work to do.
How do you measure these areas?
We have been looking at three main outcomes:
FOOD SECURITY – For which we use the USDA food security module with its 18 questions,
SELF-SUFFICIENCY – For which we have been using the Missouri Self-Sufficiency Scale, which measures changes for 10 different indicators including income, employment, education, housing, transportation, physical health, mental health, child care.
QUALITY OF DIET – The consumption of fresh fruits and vegetables, fiber and also fat and snacks. For this, we’re using the Block food frequency questionnaire.
So, tell me a little more about Freshplace in action.
Clients can attend twice a month for food and once a month to meet with a project manager to discuss what areas they are interested in working on. Those goals are then reviewed in a supportive way.
That’s always kind of been an issue in terms of us demonstrating what we’re doing is improving food security because of the limited amount of a person’s total diet that is derived from a pantry’s food. The other unknown has been that we don’t really know how many different sites people are attending. How did you deal with that in your study?
In our population, people are going chronically to different food pantries on average two to three times per week averaging up to four different pantry providers accessed every month. I think a key piece that I think you write about beautifully in your blog is the notion of how food banks around the country are now starting to question how much longer they are going to be able to increase poundage and numbers of people served without significantly investing in preventative measures – whether health and nutrition education and empowerment or the advocacy to change things. I’ve argued for a long time that hunger is about more than just food and that I think the data that we see nationally and we’re seeing at Freshplace is that even when people are going to multiple food pantries multiple times a week and they’re getting food and they know the system of how to engage in it to the best of their abilities, that it is still not enough to increase their food security. This is reflected by our food insecurity rates nationally really remaining untouched. I think it’s time for a different way of approaching this issue.
What is the specific model of case management that they are using?
It’s based on the Stages of Change approach, coupled with motivational interviewing.
The idea is that we’re not telling folks the changes that they need to make, but working with them to determine what issues are most important in their life and what are the potential barriers that they encounter that are holding them back from reaching those goals. This type of model is used in some other types of work like HIV prevention, in trying to encourage people to have safe sex using that type of motivation and behavior change model. We actually did a little bit of research through Foodshare of all of the partner agencies that receive food from the food bank to ask them whether they were providing case management in their pantry and what specific other services they provide just to get a handle on how unique or not unique Freshplace might be within the bigger field. About half of the food pantries that responded said that they did offer some kind of case management, half did not. But of the half who said they did, very few of them actually meet monthly and do a follow up. Most consider case management as giving a referral or a brochure with some other type of information. This isn’t enough. A good Project Manager can be empowering when using motivational interviewing and in recognizing that people go through stages in their readiness to make changes in their life. If we can engage in a relationship with clients where they trust us, we can have a dialogue where they know they’re coming back in a month and we’re going to do a follow-up with them and ask how they’re doing and what their issues are.
Obviously the food is an excellent motivator for people to return for the monthly interview, but how do people reach the point where they’re food secure enough to exit the program, or would anyone want to leave and turn down free food?
We always knew that we didn’t want this program to be another dependency program where people would stay on it for years. We wanted this to be something that we could help give people a hand up and that they would want to and be able to move on. We spent some time really deciding what graduation from the program really means and giving clearer expectations so that when people come to Freshplace, they know from the beginning that there are expectations that we will offer a lot of support and services and programs, but you need to want this too so we’re going to meet with you and make sure that you’re making changes. If you’re really just coming for the food, then I think right now we give maybe three to six months of that time to really monitor are they not making any progress towards their goals and if not, if they’re really just coming for the food, then there are other food pantries in the community that offer that. So they’ll be discharged to allow other people to join the program.
There is currently a lively debate in the broader non-profit world about focusing all our attention on those who are able to improve and change their lives, because they are the ones that can deliver us the metrics of success that funders want. In the food banking arena, this would be ensuring the continued ability to feed all people; those with mental illness or who just can’t provide for themselves. I think it is key to build in some avenue out for those who can’t or won’t or who are simply not ready to take on this wider change element. They would still be served to the best of our care and ability, but we wouldn’t waste their time and our money on these particular types of intervention resources.
Yes. I think we face a dichotomy in our country about the issue of hunger. When I describe the work that I do, people will often say, “We’ll always have hunger.” Even though people don’t like the idea of people going hungry, there’s also this kind of acceptance that there will always be people in need. Now there are definitely those who fit into the category you just described, say those facing severe substance abuse, mental health issues, engrained generational poverty who need traditional food bank services. But I would argue on the other side nationally there are millions of Americans right now who are food insecure and not sure how they are going to feed their family at the end of the week or the end of the month and I feel very uncomfortable with accepting that. I think from the bottom up we need to work with people and empower them and build those relationships so they can be ready to make changes, but from the top down we need to ensure that in our country that if people are trying their best to get a job or are working one or two jobs, they should be able to have a living wage where they should be able to go out and afford enough food for their family.
So this expanded group of Americans who are benefitting from our services, the 1 in 6. Aren’t a lot of this new group added by the recession able to look after themselves and might find the case management approach patronizing and disempowering? They might think that they just need a break or a few more hours work or a few more benefits. Can this group really benefit from the Freshplace approach?
I think they can. Those who have fallen on hard times need more than a bag of food. They need the ongoing support and link to a range of services rather than just short term food security. We can help them build their job skills to get a better job, and they can help us in our advocacy work to press for the policy changes that will help them long term.
With our own programs we’ve initially kept close to schools basically because that’s a place whereby we can tap into deeper more long term relationships with clients and build what we call their food literacy. However we’re now looking more closely at the thinking behind and impact of our more classic types of distribution. I think in the past the philosophy was to find a poor part of town and carpet-bomb the area with cans of food, hoping that this ‘shotgun’ approach would hit the right people and improve their lives. We did serve a bunch of people who really needed the help, and some who really didn’t need the help but weren’t foolish enough to turn down some free food. We certainly did little to change the long term health or prospects of either group. Do you think it is important to transition away from these traditional mass distributions? I mean it’s not like we have as much food available to us as we used to.
I think you’re right that so often we look at low income communities and say there’s so much need, there’s so much poverty, there’s so many problems we kind of throw our hands up and just say, “Well, let’s just provide food.” I think a different approach is sorely needed, which says that these are communities that have assets and rich human and social capital, which If tapped, can do amazing things. We need to work with folks to find out why they’re struggling so much. What are the barriers in their lives? Again, it takes more time than simply giving food. And I think often Americans like the quick fixes. Programs like Bridges out of Poverty (Watch out for an upcoming post on their work) are enabling people to really self-investigate what are the issues that are holding them back in their lives. But to truly be most successful, this requires the community as a whole to say ‘how do we look at the issue of poverty in our community and how are we all involved?’ That addresses employers and schools and the bigger picture which impacts all of us. Otherwise we will stick to our quick fixes and continue to spin our wheels.
Traditional food banking makes us feel great about charitable giving, but we’re not making an impact on food security or self-sufficiency or diet quality. That’s why Freshplace offers a different model, that if we can analyze it and find out what’s really working and how we can replicate it, then it could provide an avenue for a longer term approach to dealing with hunger. Clearly, this model is not going to be feasible for every food pantry. They might serve 500 people in a week, how could they possibly provide case management for 500 people in a week? And I would say, you won’t, but I think that you could target a small segment of that group that you feel would be most ready to make these changes or people who would like to get off of that food pantry line. You could work with them and monitor their changes over time, so you would have that longitudinal data and with the expectation that hopefully six months from now they’re no longer in that food pantry line.
Some food banks may have the financial resources to hire a case manager and deal with issues that aren’t necessarily food related. The challenge for other food banks is, ‘how do I partner with other organizations that have these skills or specialty to really provide a range of services that cover more of the spectrum of issues covered by the Self-Sufficiency screener?’ What kind of models do you think would work for that partnership?
My interest is in translational research, making sure that things are meaningful on the ground. An academic study is not as much use if other people can’t use this information. One of the things that we did with Freshplace is to partner with the social work program at the University of Connecticut with the idea that many communities that already have food banks often probably will have some university or college setting that would have a social work program and those social work students need hours in the field of working. They need that expertise and experience so that can be a way. We’ve had two women who’ve come through the social work program who’ve worked with the paid case manager through Freshplace who are getting their hours towards their degree and I think that’s a model that other communities could use to partner with other existing programs in their area that wouldn’t necessarily require a lot of funding.
I then spoke with Gloria McAdam, CEO of Foodshare.
Gloria, the results from Fresh Place are looking very promising. I understand that you are aiming to scale the program – are you just planning on providing your own case managers or cooperating with other nonprofits.
Our original vision with the Freshplace model was to be able to replicate it throughout our service area. For example, in the City of Hartford, which is only 17 square miles, there are currently around 90 food pantries. Since most of these pantries give out meager amounts of food and offer no other services, this structure forces clients to go from one pantry to another, just to put food on the table. We believe that a much smaller number of pantries, probably 10-15, who operate on the larger scale that Freshplace does and provides these additional services, could serve people much more effectively.
We could do a better job of getting people the food they need for sustenance as well as providing additional services and supports that would move those families toward self-sufficiency. Our next step with this project is a replication manual and to start identifying new partners for expansion.
In addition, we are considering the idea of hiring a case manager on Foodshare’s payroll who would rotate among a few smaller agencies to test whether case management can also work in smaller food pantries. We are just in the thought phase of this idea – what would it look like, what would it cost, which agencies might be interested and where would the funds come from.
That’s great work Gloria, thanks to you and Katie for sharing and keep us informed as things progress.
It’s great to have a nonprofit’s name in the form of a question. It is a good way of having the conversation with the community already having begun before you open your mouth. In the case of Why Hunger? this conversation has been going on for 35 years, ever since singer and activist Harry Chapin first posed the question and then even better, got together with founding (and current) Executive Director Bill Ayres to do something about it.
The organization is a grassroots support organization that tries to build the movement against hunger and poverty by amplifying the voices of innovators who we think come from the grassroots.
At the recent Feeding America national summit, I met with Harry Chapin’s daughter Jen Chapin, who is a wonderful singer-songwriter, who some in the western region may remember from her address and performance at a conference in Tucson last year hosted by the Community Food Bank of Southern Arizona.
I also had a chance to speak with Jessica Powers, director of the National Hunger Clearinghouse at Why Hunger? Below are excerpts of my discussion with her.
The organization has been working on an essential new resource for those running nutrition programs which has just been made available.
So tell me a little bit about the types of support that Why Hunger? provides.
We do training and technical assistance. We do capacity building through some small grant programs, and we also use the vehicle of storytelling a lot. We try and find out about innovative approaches that people are using, and we try to amplify those voices to a wider audience in order to inspire people about things they could try in their own communities.
Can you give me an example of what you are working on?
Sure. Through our grassroots action network, we currentlyhave 3 food desert projects that we’re working on. The technical title is ‘building community power to eliminate food deserts’, and we’re working in Southwest Arizona, in the Mississippi Delta, and in Central Coast California.
And what we do is we bring together different stake holders who are working on food systems issues who may not be talking to each other currently, so that might include ranchers, people from public health, people from the school system and food bankers. And then through a facilitative process, we talk about the history of that area, how they got to the current situation that they’re in and what their vision for the future is. Our role is really to facilitate moving that forward that we actually think the community should determine for themselves what is the best solution for them, but that our role is to help move that forward by being sort of a consistent presence and helping with any challenges that arise in moving the work forward.
Tell me a little bit about this guide which is now available for people to download from your website. [DOWNLOAD HERE]
The National Hunger Clearinghouse works on capacity building for emergency food providers, and we focus mainly on food pantries and smaller agencies. Through that program, we had a lot of conversations with people, and they kept saying that there was a lot of innovation happening in food sourcing and nutrition education, and it was really hard to find out what was going on and to find a place which could be a hub for that information.
We did research and created program profiles on a host of organizations that are working on those 2 different issues. And so we organized them sort of by strengths. So in the nutrition education guide, we’re looking at programs that maybe are better at working with diverse communities. Some are better at evaluation. And the idea is that people can then tailor it to the program that works for them in their area.
(The ‘From Hunger to Health’ blog is also cited in the guide, so let’s hear it for cross-promotion, folks!)
Has your organization done any work to uncover the roots of hunger, and answer that tricky question, “Why?”
Yes, in many ways, that is our mission. We have a Food Security Learning Center on our website which is an encyclopedia of food system issues. Everything from water to community food assessments to race in the food system, youth in the food system etc. We have a particular lens, which is that we want to see healthy nutritious food available to people. So the articles are definitely written with that lens. But I guess the big thing that we do is try to disseminate information and try to share stories with a wider audience.
What do you think food banks could do or be involved in that they are not currently as a whole involved in?
I think that we all acknowledge that the root cause of hunger is poverty, and if we’re not talking about poverty and solutions to that, then we’re spinning our wheels. So I would challenge food banks to do more of that, to talk more about wage disparity, to talk more about living wages and healthcare and things like that, that are forcing people into the position where they need emergency food assistance.
This came up in the speech by Matt Habash, last year’s winner of the John Van Hengel Award (Prestigious food banking award), and he was encouraging people to make that link to poverty. But in subsequent sessions that I attended, people from other food banks were saying, “Oh my god, I can’t go near that because it’s a political hot potato, and it’s outside our wheelhouse, etc.” Are there other things that they could do?
It is not only a case of the food bank using its own voice. They could be sharing more information and insights with the agencies that they work with, and helping them build their advocacy skill set. They can also use State Associations as more of the political voice.
I think it is a question of framing. It has to be about opportunity. The whole childhood hunger piece, when you talk about children having an equal opportunity to become leaders, to become educated. I think that’s something most people can agree on regardless of their party politics. And I don’t think that people talk about that enough.
So are you suggesting that food banks take more of a leadership role in putting together coalitions and becoming the backbone organization for a wider variety of community organizations?
Yes. Increasingly we’re seeing that there is a political movement that wants to privatize charity. That means putting the burden onto the food banks, so I think food banks need to stand up to this. When you look at the total pie of food distribution, food banks are still a relatively small piece in this country and so they can’t be expected to take on such an increasing burden, and I think they need to be more vocal about that. I think when we have discussions that are based solely on poundage or distribution or logistics or supply chain, then it sort of takes away from our ability to say, “Hey, wait a minute, this is supposed to be an emergency response, not a long-term solution,” right?
Thanks, Jessica, and thank you for your work in putting together such a great guide.
Is there a life after food banking? Apparently so. Mari Ellen Loijens worked in development for Second Harvest Foodbank in Santa Clara and San Mateo County from 2000 to 2004, and is now the Chief Philanthropic Development and Information Officer for the Silicon Valley Foundation.
Of course it is every fundraising professional’s secret fantasy to then go on to work at a foundation and give it away rather than have beg for it. (Without appreciating the challenges that go with such a responsibility). So what’s the difference between your time in the food bank looking out, and outside the food bank looking in?
When I was at the food bank, the needs were constantly growing. There was no single year where we had to feed less people than the year before, and I had a strong sense of urgency about the growing need. Now that I’m outside, it seems like it’s endless and I’m more anxious for real solutions to the issue. It’s sort of like being an emergency room doctor, and your concern is how to bandage all the wounds for those who need immediate assistance. Then when you walk outside the emergency room, you think, “How can we avoid the people going there in the first place?”
That’s a question a lot of food bankers are asking themselves. Like me, they’ve seen the capacity of food banks grow with their success at fund raising and their ability to bring more food in to their service area. This has created more ongoing demand, so it’s kind of a spiral. How do you think that food banks could get out of this demand spiral and move towards a long-term solution?
We really need to look at some policy changes. We are a very wealthy nation and the notion that we have so many people who turn to others for such a basic need is troubling. Clearly there is something wrong with a system in which many children go to school hungry.
Food banks and other nonprofits are always very reluctant about stepping into these waters, because they worry about offending donors whose political slant may lead them to believe that we are just ‘enabling’ people. How can we navigate these waters?
I think that the problem is that we focus too narrowly on just food. If you only think, “I need to feed people,” and you think, “That’s my only issue,” then we’re back to the doctor in the emergency room who would be saying: “I’m trying to get people to stop bleeding, and it’s so expensive to keep using up all these wound dressings. So the solution is that we need more money for more wound dressings.” It’s a symptom he’s dealing with, not the cause. In the same way, hunger is the not cause, it is the symptom of a greater problem in our system. This comes down to something like minimum wage. Do we have a living wage? Are people able to earn enough where they live in order to take care of something as basic as food and shelter? We have got to move beyond pushing for increased SNAP (food stamp) benefits and into the bigger issues like: How do we make sure people, who are able, can earn enough money to feed themselves and their families?
So, are you saying that hunger is a symptom of the condition of poverty, or of something else?
I think poverty itself is also a symptom. I’m not a socialist or a communist. I don’t believe that everyone should make the same money, but I do believe that Americans, if asked, would say it’s wrong to have a system which forces people to constantly be in abject poverty and unable to get out of it, even if they are working hard, perhaps at multiple jobs. At some point, we are going to have to make decisions about how we pay for our beliefs and values. In the same way we are asked to make tough decisions now about taxes and how we want to pay for the things that we believe our country needs, such as roads or to provide the fire and police services that we want. In the same way, we have to ask ourselves the question: if we think it’s wrong for a child in a developing country to make a dollar a day sewing t-shirts, how are we going to provide an adequate minimum wage so that people in America who work a whole day can feed themselves and provide at the most basic level for their families?
And so how do you see the situation in America now?
I think we have an unspoken social contract in this country which prevents people from moving up out of poverty, and much of that is as a result of not have a living wage in most places. We also do not have systems in place that update the minimum wage as the cost of living modifies in an area. The systems that we do have reward the wealthy and do not help the poor. This means we have to really look at our whole social contract as a country and our value system and say, “Have we set in place laws that support the values that we claim are American?”
This is the point in the conversation where people begin to squabble about the meaning of the ‘American Dream.’ I see an unspoken fear in many donors I talk to. I would preface my comments by pointing out that these donors are caring and generous people who sincerely want to ‘pay it back’ and provide some level of support for those in need within their communities. However, they may have a voice deep within them, that reminds them how hard they had to struggle and sacrifice to get where they are, so why should they make it easy for someone else? They often don’t see the incredible daily sacrifices and struggles of those in poverty who can find no success story on the back of their struggle.
This is why food banks have been so successful, because there is a lot of interest in ameliorating the symptoms but a deep fear of taking the plunge to actually deal with the causes. Either donors are concerned that they will be heavily taxed and lose what they worked for, or they fear that the fabric of American society will change and everyone will expect things to be provided for them without working for them. Consequently they see America losing its ‘can do’ spirit of entrepreneurship and resourcefulness. The type of change that is required to actually deal with a problem is too scary. The same thing is true for issues of immigration, health care and the rest of the sad litany. This means we have to stand around with our hands tied or else harken back to some previous time in our country’s history where these problems were better hidden.
I think a new consensus for action needs to arise that returns the much-loved but threadbare teddy bears of left and right political philosophy to the nursery shelf, and for us to admit that we have grown out of them. They’ll always have a fond place in our heart they were both great in key moments at getting us to the point we are now at as a nation, but now they are getting in the way as our nation enters maturity. These security blankets are getting under foot and gridlocking our ability to do what we do best as Americans – which is to fix something in a no-nonsense straight-forward way.
I know from over a decade of working to assist either the homeless or the struggling, that the amount of people sitting on their gluteus maximus and freeloading their way from society (amongst poor people, anyway) is absolutely tiny, just as the amount of people defrauding SNAP benefits is a minuscule amount in relation to the total. Are we going to allow an obsession with preventing the enabling of a few who don’t want to help themselves hold us back from making huge achievements as a country for the vast majority of Americans who work so incredibly hard?
Can you imagine what greatness we could achieve as a nation if we weren’t all so consumed with fear about being able to get affordable medical help, or that we will be living in abject poverty as senior citizens? Modern free market economies are driven by so much advertising and marketing, that are showing people all the things they need to have in their lives to be happy. These forces provide a huge encouragement for people to produce more and earn more. If we can provide a counter-balancing support safety net for all Americans, it won’t extinguish this desire for more – which is equally part of the American temperament. The two can complement each other perfectly well. It’s not exactly a shining city on a hill, but it’s a workable system where we can all move forward at our own pace and to our own ability.
Forgive me for that. As a food banker, if you see a pile of pallets, then your natural inclination is to climb on top of them and start spouting off…
That’s quite all right, Erik. Keep breathing. Seriously, though, I think food banks need to get get braver about legislation. You need to move past the daily problem of feeding people, and start to collaborate with others that can focus on solutions and really start to ask the difficult questions of, “What’s the issue?” Yet for reasons that you mentioned, like when you referred to SNAP fraud, I think food banks are very afraid sometimes of moving in that area, because if you did a survey of people you feed and even one person said, “Well because I don’t feel like working.” That’s a terrible, terrible fear of food banks. Suddenly, no one might want to fund their food bank, because there is one person whose is working the system. So essentially, we are ready to punish and live in fear of that one person. Well, there is always going to be someone working the system. There are people who go to emergency rooms, because they don’t feel like paying for a doctor. We absolutely can’t set up systems to deal with that one person. We look at the big issues in our country like educations reform and how healthcare reform and you hear about those things all the time. I would love to hear our country talk about poverty reform. How we are going to help make a sweep of changes that would impact the base line of our country and help bring people who are essentially stuck because it’s impossible to move on or move out.
So, who do you think are the right people to lead this movement or does it need to come from a ground swell at a local level?
I think both. That is how the civil rights movement happened. You start with that real grass roots movement from people who are experiencing the issues and people who support those people. Then at some point you get the attention of people in a power position with legislation to be able to move those issues forward.
You mentioned that food banks are timid on the public policy front. What else do you think food banks could do to make this happen?
Well, I really like the ideas espoused in your blog about how your food bank is working on regarding entering the preventative healthcare arena. I do think that when you start to see yourself as part of a wider system rather than just an individual issue, then you are able to address bigger issues that have bigger impact. Poverty is not the root cause. People became poor for a reason. The fact that they are poor is not the issue. The fact that they became poor and can’t get out of being poor is the issue.
This requires food banks to build broad coalitions with other social service agencies in their service areas, some who may be member agencies and some who may not.
That is a challenge, because there is often reluctance for everyone to sit down and have a substantive dialogue about how do we move things forward? The subtext from non profit leaders can often be: “I don’t really want to be in a room with them. I don’t want to compete with them.”
Hey, you’ve been in some of the same rooms as me!
That’s the truth about a lot of nonprofits is they’re just completely uncomfortable with the idea of competition, and if I had the answer to this issue, I’d probably be able to save the world.
Well, we’re non profits. Competition is way too business-like and vulgar for us, right?
Yes, you’re very sensitive souls. But, it has to start with non profits admitting it is an issue. Then I think, speaking as a funder, that there is a clear role for funders in facilitating this issue. I think it’s all power dynamics. The one with the power has the obligation. Foundations really have the obligation to reach out to the nonprofits and say, “I really want to know and I really want to understand what’s going on. Why is this collaboration and conversation not working for you? Where they don’t have to sit in front of their competitor and say what their fears are. We can ask who would you want to collaborate with and how, on what terms?” I think having an honest dialogue is what moves things forward. This sort of thing needs to occur one on one or in small groups. Large gatherings can neutralize everyone’s desire to make anything happen.
I think what you say about the competition angle is very interesting, because it’s kind of taboo to talk about nonprofits competing. To be a good non profit citizen, you can only talk in the language of shared impact and collaboration. It might be very liberating for people to also have a conversation about competition and to say it is absolutely all right. I presume there is fear that we would be acknowledging duplication of service if we acknowledged competition. Certainly something for people to consider starting a discussion about in their service area.
How do you think food banks and other human services and nonprofit should be thinking about evolving their funding streams over the next few years?
I think if you are looking for systems change, at some point that goes against the grain for sustainability, right? You want to be working towards your services not being needed anymore. The ideal is that you want to be able to talk about what system changes are you creating, so that you should have to provide fewer and fewer services every year? That should be the big boast. “Last year we fed 200,000 people, but this year, thanks to our hard work, we only have to feed 150,000.”
But every nonprofit organization in the world is afraid to do that, because then they assume that the funders will come back and say, “Oh, you need less money this year.” And so the organization declines.
I think that there is a new generation of funders that have a very different way of thinking, and that what people really want to see are problems solved. People are tired of the same problems staying around for generations and generations. You’re right, though. Every nonprofit I know like to boast about how they did even more; served even more. It is a treadmill. But this new generation of funders comes from a very different way of thinking that would say: “No, no, no. The metric I care about is not how many people you serve, but that you made systemic changes so you will have to feed fewer people moving forward.“ It is a way for your organization to evolve to be truer to its mission.
Mari Ellen, thanks so much for your ideas and for your work supporting non profits.
Dr. Hilary Seligman, MD, MAS, is an Assistant Professor of Medicine within UC San Francisco’s Center For Vulnerable Populations and a general internist at San Francisco General Hospital. She is also affiliated with the UCSF Center for Obesity Assessment, Study and Treatment. Dr. Seligman’s work focuses on food security and its effect on the development and management of chronic diseases such as obesity, hypertension, diabetes and heart failure.
There is a reasonable amount of awareness about the health burden that food insecurity places on early childhood development, but not so much with adults, and I find that a really interesting element of your research.
We have largely ignored the long-term health implications of food insecurity among adults. And so what I’ve tried to do is firstly figure out if there are health implications for adults, and – yes – there do seem to be important health implications. They’re a little harder to talk about because it’s a little more complicated than just saying iron deficiency anemia, but I think the message needs to get out there that food insecurity has nutritional implications that are important, not only for children, but for adults too.
We all get so amped up trying to save the next generation that we forget the current one – and that would be you and me, folks!
A key element, which I think has wider relevance as we help our clients with their nutrition, concerns the cycles of food adequacy and inadequacy. We might expect a compensatory strategy of skipping meals, (leading to hypoglycemia) during times of food shortage, but you demonstrated that even when these people had enough food, it led to systematic overconsumption – people wanting to feast now that it was not a time of famine – which had similarly negative effects on the control of their diabetes, leading to hyperglycemia.
Yes, and food insecure adults required about five more physician encounters per year than those that are food secure.
In so far as the Food Bank Network touches an extraordinary number of people, and particularly people who are very high risk for the varied diseases that food insecurity predisposes people to, namely obesity, diabetes, and other diet-related diseases, food banks really present an unbelievable opportunity to be part of the solution to the nutritional inadequacy and the typical food-insecure adult diet.
So what do you think food banks should be doing to help address this situation?
Food banks often reach a person at least once a month, in a context that allows them to talk about diet and provide nutritious food. People are much more willing to talk about their diet when they go into an environment in anticipation of leaving with food. And then it’s the challenge of what kind of food does the food bank provide, and how much of that food will provide a high nutrient value.
As distributors of food, we can potentially get stuck in a place of having to provide clients with donated food which may provide them with an overgenerous supply of calories but that doesn’t do much to build their nutritional health. The other tough place is unsustainable spending healthier food, which even with the buying power of a food bank can be hugely expensive.
Totally. There are huge distribution and logistics challenges. I think what we have to do is take the first step which is to look at it and acknowledge that obesity and diabetes are a huge problem in the clients that are served by food banks and that food banks have the potential to greatly assist with that management.
We are now in a new situation where the ‘emergency food’ situation is becoming the new norm for a large number of our clients. Do you think that requires a greater degree of responsibility for what kind of food we are distributing?
It does. Food banks are being asked to feed people year after year after year because SNAP is underfunded. And that’s where we get the problem. It is the chronicity of use I think that makes essential an increased nutritional value in the food bank offerings. The other thing that’s changed is that an individual calorie has become so cheap that it’s really easy to get too many of them. You can get a lot of calories from poor food and feel full, but you won’t get any nutritional value from it. This is especially true of the food insecure clientele accessing services from a food bank or member agency.
I’ve heard the argument that non-nutritional calories (Twinkies and chips and pretzels) are so cheap that anybody can afford those in the United States, and the food bank should only be there to provide fruits and vegetables and other very healthy food items. That is a more extreme view, right? That’s not necessarily my absolute view, but there is a certain value in considering whether clients can afford more expensive calories, and therefore considering what type of food that food banks should be providing in the future.
Particularly as access to these cheaper calories become more difficult for food banks, as corporations continue to become more efficient with their inventory. If the food in a food bank resembles the proportions of the contents of the USDA’s My Plate, that would be an ideal situation: half fruits and vegetables, a quarter whole grains and a quarter protein – lean meats and protein substitutes.
Our food bank is pursuing a steady transition to a specifically preventative healthcare agenda. Our goal is to leverage short-term relief of hunger and food insecurity into longer-term shifts of client behaviors around food leading to better health. This means an integrated series of programs starting with expectant mothers and following children through right up to the high school level. This means outcome-based evaluation, which is very challenging, yet we feel it is essential to gain the credibility to exist in this new and potentially very powerful space. However, we’re nothing if not a joyful ‘Heinz 57 Varieties’ of a network. Do you think that there is a lot that any food bank can do to move forward a healthy food agenda without having the particular focus that we have.
Yes, I think every food bank can make big strides, whatever their resources or approach. The link between dietary intake and obesity and diabetes is clear enough that just documenting an increased intake or increased access to fruits and vegetables is enough to create an important public health message to the client group.
By the same token, you don’t necessarily have to show that BMI goes down or that diabetes is better controlled, because that link is well established enough. Just showing that fruits and vegetables are desired, they’re taken, and they’re eaten at home rather than ‘they spoiled and I threw them away,’ that’s enough.
Surely education – in what we like to term food literacy – plays a key role here?
Yes, the evidence in the academic literature suggests that protein is the most significant problem, because clients are reluctant to shift to non-meat proteins. Particularly in low-income communities, it’s not considered a meal unless you have meat, and that’s not the most nutritious message. Other protein sources like beans and lentils and tofu are cheaper than meat and offer great nutritional value, but that’s an education message that we need to be communicating as well, and it’s often a hard sell.
What doesn’t seem to be as much of an educational issue is fruits and vegetables. People like access to fruits and vegetables and will take them it when they are available, and when they take it, they eat it. So the bigger educational barrier to me seems to be in the protein choices. In terms of fruits and vegetables, the big place where education needs to be done, I think, is with produce that people aren’t so familiar with, whether for cultural or other reasons. Particularly because these less familiar fruits and vegetables often end up at food banks.
Tell me about it! Every day for us is ‘Three Hundred Things to do with a Persimmon.’ Martha Stewart has nothing on us!
So, I would like to ask you what is your definition of optimal food security? How can we define it in an individual seeking our services and how can we measure our interaction with that person to know whether they are able to attain it?
That’s a great question. You know, this is, again, my personal opinion. People will disagree with me. But I think that the way you know someone’s food secure is they’re not coming back to the food bank. Even if you report on a food security survey that you’re not worried about running out of food because of money, 99% of people who answer that they’re food secure on a survey administered by a food bank are doing so because they have come to rely on that food bank as a chronic source of their food intake. And so they don’t need those additional food resources because they have the food bank.
So where would you like to see the Food Bank Network in 5 years, as relates to this area?
I would love there to be some relatively straight forward way that food banks can record their product as high nutrient value versus standard nutrient value, so that there is a simple way to track improvement.
Feeding America is looking for other markers of success that are more nutritionally than poundage focused, and of course different food banks are already using systems such as CHOP (Choose Healthy Options Program) to rank their food.
Yes, though I think oftentimes they’re difficult to operationalize. So I would love to see that food banks can set individual quality goals around improved nutrition. Many food banks already have the skills around refrigeration and quick distribution, so it is more about developing the infrastructure for all food banks so they can respond if say a farm were to call up and say I have 100 pallets of broccoli, will you take it? Many food banks would say, no, we can’t take that much because we can’t refrigerate it or distribute it quickly enough. This is a hurdle that deserves to remain a major focus.
Hilary, thanks for your significant research in this area and for your support of and belief in the work of food banks.