Food Pantries with Case Management build both Measurable Food Security and Self-Sufficiency

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.

Downloads are available here with the top level Freshplace Research Update as well as a Case Management in Food Pantries Research Brief. I spoke with both Katie and later with Foodshare’s CEO, Gloria McAdam to see what practices or ideas we could take from Freshplace.

 
Katie Martin

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.

The bit the Hartford Tourist Board want you to see.

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 J. McAdam

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.

Are Non-Profits afraid of Competition? How can we tackle the root causes of hunger in America? Tough Questions from a Community Grantmaker – A dialogue with Mari Ellen R. Loijens, CFRE.

Mari Ellen Loijens

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?

Want to dip your toe in…

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?”

Bumper sticker seen outside Santa Barbara’s swankest hotel.

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.

Whatever the sentiment, Uncle Sam gets pressed into service to wag that finger.

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’ve been manhandled so much, I don’t remember whether I’m Republican or Democrat.”

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?

Sounds great, we should import that stuff to America! (Cheaply, of course)

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.

Nothing wrong with a little friendly competition.

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.

What Every Emergency Food Provider Can Do To Boost Client Health: A Dialogue on Food Insecurity and the Management of Chronic Disease with Dr. Hilary Seligman

Dr. Hilary Seligman, MD, MAS

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!

At the recent Feeding America summit, you made a presentation that used diabetes as an example of the intersection between food insecurity and the successful management of chronic disease. (Food Insecurity and Health Presentation Feeding America Network Summit 4.19.12

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.

Since the dawn of time, mankind has worshipped the Twinkie. (And it’s still fresh).

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.

Why did this glorious union never capture the imagination of the Great American Public?

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.

When in doubt, have a festival! Still time to book for this August, Lentil Lovers!

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!

Only Martha could make Food Insecurity aspirational…

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.

I have a dream, where little white birds and little black birds pick up little spoons and feed all the boys and girls.

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.

RESOURCE

Link – Journal of Nutrition, 2010 February –  Food Insecurity Is Associated with Chronic Disease among Low-Income NHANES Participants


Food Insecurity’s effect on life-long health or the link between Elvis Presley, Fools Gold, the Indy 500, Miss Teen California and the Alien Mothership…

Today our focus is the covert connection between Elvis Presley, the Indianapolis 500 race, a deadly substance known as Fool’s Gold, Miss Teen California and an alien mothership. For the good of humanity, and at risk of a mysterious death at the hand of unknown assassins, this strange tale must be told…

It began this very morning. A grey and unremarkable morning, except it wasn’t. Today was the Foodbank of Santa Barbara County’s 30th birthday, and here is the cake to prove it!

Relax, it’s a carrot cake…

Back in 1982, I was a callow long-raincoated student at University College London, listening to Joy Division, working on my greasy fringe and trying to impress girls with my knowledge of obscure foreign films. But in 1982, here in Santa Barbara County, they had their act together a little more than I did, and they were responding to the urgent need to source and store food for use by our county’s nonprofit organizations.

The Portrait of the Artist as a Young Man

All this year, we’ve been honoring this mission and acknowledging the achievements that saw a transition from 82,000lbs distributed in our first year to over 11,000,000 pounds last year, of which half was fresh produce. At the same time, we have been turning our gaze to what needs to be achieved in the next 30 years. We will see a very different Foodbank by then (and I suspect far before then) which is much of the focus of this blog, but I would like to consider something else that will be apparent 30 years from now, the legacy of the food environment that our children are facing today.

An essential part of any food pyramid…

Thousands of children in our service area are facing malnutrition that is hidden behind brightly colored packaging and the hard sell of 360 degree advertising. The outrageous nature of fast food has reached giddy new heights with news of the Crown Crust Cheeseburger Pizza, which Pizza Hut is currently unleashing in the Middle East. (Obviously when smart bombs fail, it is time for the junk bomb).

As you can see from the comparative photos above, this is the mothership of fast food with mini cheeseburgers embedded jewel-like into the crust of the pizza. Maybe you should even savor the commercial, though there are probably a few excess calories involved in even doing that…

Now back to this morning and the cake. Behind that man who could afford to lose a few pounds (me), there is another man sitting on a motorized wheelchair (Andy Granatelli) who could certainly stand to lose a few more pounds. Andy is a local SB legend and Indianapolis 500 race car driver, who for many years was the face behind STP commercials.

Bobby Unser is in the driving seat and Andy Granatelli is the only one in a suit. (Guess the drinks are on him).

Andy attended our event to show his appreciation for our mission (“They feed hungry kids,” he shouted to attendees whenever he got the chance.) During his remarks he referred back to his childhood in the Great Depression (Maybe what we have now is the ‘not so great’ depression) and how his family were always hungry and struggling to find food. This had become more than just a bad childhood memory to put behind him, but had actually shaped his health significantly in the intervening years. He is obese and diabetic and sees a clear correlation between this and his childhood.

“Love me well done, Love me with extra relish, all my dreams fulfilled…”

This got me thinking of Elvis Presley, another person whose future health was shaped by an early experience of hunger. Squirrel and other roadkill were certainly not unknown on the menu of the young Elvis. The gospel elements of his vocal style can be traced to the fact that as a young boy he was brought to many churches in the South because of the fried chicken dinner offered to congregants after the service. Food became somewhat of an obsession with Elvis, and as he became more popular and money was not the issue, the need to binge eat (a habit of the food insecure who have no surety that there will be another meal anytime soon) became more and more pronounced.

It could be an alien autopsy. You decide…

One example is the Fool’s Gold Sandwich, weighing in at 6000 calories. This is an infernal combination of a pound of bacon, a jar each of peanut butter and grape jelly and a whole loaf of bread – though by the look of the photograph, there could be some kind of road kill in there. Elvis would have six of them made at the restaurant i n Denver that specialized in them and then fly in by private jet with his entourage and consume them in the airport hangar washed down with Champagne.There is actually a great book looking at Elvis’ life through the lens of food, called ‘The Life and Cuisine of Elvis Presley.’

Both Elvis and Andy found it impossible to escape from that formative relationship with food. Many of us have emotional triggers that cause us to eat mindlessly and to excess – imagine how they are multiplied if your body and psyche have real experience of doing without food.

Miss Teen California is the one on the right

There is a link for me to another person keen to be in the spotlight of media attention. A couple of years ago I met Miss Teen California (such is the glamorous life that I live) Dedria Brunett (yet a blonde). Dedria had gone through the foster care system and was an adopted child who survived her early years by finding food in trash cans. When we met, she talked candidly about capturing bugs to eat and the binging and purging that was the legacy that still remained from those days.

What we can’t get away from is the list of diseases growing inside people as a result of what they’re eating. If the Foodbank is going to step up and admit some culpability (don’t sue us) for provision of less than healthy food in the past, then it is about time that manufacturers of these tasty chemical treats started having to pay for some of the real world health consequences of their business activities. The ‘fast food settlement’ anyone?

Old and young are facing the after-effects of a childhood of food insecurity. Thirty years from now the children facing this now will be facing a new reality of diabetes, heart problems, danger of strokes and diet related cancer. Our new Elvis Presleys are storing up a lot of trouble and it’s our job to intercede before it’s too late.

Feeding America CEO’s message to network: Adapt or Die?

Adaptation is a rare thing. For one thing, it is the title of that rarest of things, a good Nicholas Cage movie, but rare also when it comes to nonprofit organizations who see that their own continued success is dependent on a major change in its approach or operating model. Adaptation was the main theme of the keynote address to the Unity 2012 summit by Feeding America CEO, Vicki Escarra.

She told the audience of several hundred food bankers from around the country that getting food and distributing it was no longer enough. Building bigger and bigger food banks was no longer enough. That it was the role of the network of food banks to lay the groundwork for change so fewer people need assistance, and to improve the wellness of clients so that they are healthy enough to move toward self-sufficiency.

Yes!

If this blog and the work we are doing in Santa Barbara is about anything, it is about this. Amazing amounts of innovation come out of the network, but  to hear the CEO of Feeding America say something like this in a keynote to a group of food bankers (comprising a good number of people who have been perfectly happy pushing more and more food through the system, and who would view looking at their mission as anything else as heretical )- it was still sweet music.

As I sat in one of the sessions, I was inspired to doodle a physical representation of this adaptation and what it would mean for Feeding America. This graphic comprises my view of what should happen – I don’t think Feeding America are going to drop another $20 million on a rebranding to adopt my new version of the logo, but nevertheless…

Evolution: Time to pull ourselves up out of the dreaded pink slime…

As Escarra related it, this concern about getting stuck and becoming a dinosaur came to her when she was literarily surrounded by dinosaur bones at a Boston Consulting Group conference that was being held in NYC’s natural history museum. The report to this conference indicated that the world was facing a period of prolonged turbulence with some fundamental shifts occurring for companies to be aware of. The gaps between winners and losers is growing. The link between profitability and industry share has virtually vanished. The traditional ways of planning and building competitive advantage have changed too. Instead of being good at one thing, companies need to be good at learning to do new things, and quick to read and act on signals of change.

Non-profit leaders taking the risk to leave their conference hotel and hit the streets.

Escarra admitted that this openness to change was also linked to the realization by her organization that increases in awareness of the issue of hunger in America were not being met by a commensurate level of response of people taking action to do something about it. Three years ago, everyone got the issue of emergency food. Everyone knew someone who lost their job and was suffering. After three years of banging away at the level of ‘Emergency, Emergency, Emergency’, people are not viewing it as an emergency anymore and want to move on.

Escarra related that great companies were fostering a culture of innovation generated by unlocking the resources of the people who work for them, and that the network of food banks would also have to rely on innovation to remain relevant. This would mean that rapid testing of new ideas and scaling those that were successful had to be the cornerstone of the way the organization moved forward, whether it was new ways of sourcing the next billion pounds of food or new ways of fighting chronic diseases like diabetes through the activities of food banks. As the world evolved, so Feeding America would have to evolve with it.

It sounds like the movement from Hunger to Health now has a powerful ally, and I for one will work to ensure that this change in the conversation becomes something more lasting – a network-wide evolution of food banks to move beyond emergency treatment and into preventative treatment.