Harvesting health and hope through farmer-health care cooperation
How hospitals can decrease hunger and heal communities
“When our 11-year-old daughter was diagnosed with cancer, as an undocumented family our [food] resources were very limited. We are so grateful for La Cosecha because it was how we started as a family to find solutions for what we could do with our limited resources in battling this serious illness.” — La Cosecha patron
Many families struggle to secure enough nutritious food for a healthy life. They may skip meals, cut back on the amount or types of foods they eat, or make the difficult decision to pay for necessities like medical care and utilities over food. Presbyterian Hospital in Albuquerque not only recognizes the vital link between healthy food access and patient outcomes, but they are also putting their community benefit dollars to work on solutions for food-insecure families in their community.
La Cosecha (which means “the harvest” in Spanish) is a community-supported agriculture (CSA) program started by the Agri-Cultura Cooperative Network, a farmers cooperative based in Albuquerque. Like other CSA programs, La Cosecha offers its members the opportunity to invest in local farms and receive a share of the harvest — weekly boxes of organic produce — in return.
What sets this CSA program apart is its strong partnership with a hospital. This collaboration makes a clear connection between health care and healthy food by bringing fresh produce to some of the most underserved communities in the South Valley and the International District.
Since 2013, Presbyterian (along with other organizations) has subsidized the CSA shares, as well as completely covered the shares for 40 families to ensure the CSA is affordable for low-income families without jeopardizing the ability of the farmers and farmworkers to earn a fair wage.
The CSA has grown into a multi-sector partnership that serves 350 families, improves community health and food security, and provides some of the participating farmers with 62 percent of their income.
Assessing — and meeting — health needs
Albuquerque is largest city in New Mexico, but despite the predominantly urban setting, there are still many areas with limited access to grocery stores and a lack of affordable produce. New Mexico has a higher-than-average rate of food insecurity, especially among children: one in three children is food insecure, and one in six adults is food insecure.
Nearly a quarter of the population of Bernalillo County, which includes Albuquerque, has low food access, resulting in a food insecurity rate of 15.8 percent. Three in four adults report inadequate fruit and vegetable intake. These factors contribute to the rates of chronic disease in the county. Among adults, 23 percent are diagnosed with high blood pressure and 6 percent with Type 2 diabetes.
Food insecurity is a major public health issue and has implications for community health, clinical care, and rising health care costs. According to Feeding America, 41 million people in the United States struggle with hunger, resulting in widespread effects on physical and mental health. Food insecurity is associated with significantly greater emergency department visits, inpatient hospitalizations, and lengths of hospital stays. It can also mask underlying conditions or present symptoms that clinicians may misinterpret.
Only 20 percent of health can be attributed to medical care, while physical environment and social and economic factors account for 50 percent.
This makes addressing unmet social needs like food insecurity a logical place to invest to improve community health and patient outcomes. As anchor institutions committed to improving the health and wellness of those they serve, hospitals are well positioned to play a key role in addressing community food insecurity and healthy food access.
Investing in solutions
Community benefit investments are one way nonprofit hospitals can begin to collaborate with other stakeholders and address some of the social determinants of health.
Private, nonprofit hospitals throughout the United States are exempted from paying taxes and are required to provide benefit to the community in return.
To meet this obligation, hospitals historically have provided free or reduced-cost care to qualifying patients.
However, the Affordable Care Act outlined a new IRS requirement that tax-exempt hospitals must conduct community health needs assessments and make them publicly available at least once every three years.
Hospitals must also produce implementation strategies designed to address the priority health needs identified in the their communities. Hospitals are encouraged to look beyond a narrow focus on access to care to the need “to prevent illness, ensure adequate nutrition, or to address social, behavioral, and environmental factors that influence health in the community.”
Created with support from the Robert Wood Johnson Foundation, Health Care Without Harm’s “Delivering community benefit: Healthy food playbook” supports and inspires hospital community benefit professionals and community partners in developing initiatives to promote healthy food access and healthy, local and sustainable food systems.
The playbook is a comprehensive repository offering information and tools to address food- and diet-related community health needs at several steps in the community health engagement process.
“Hospitals featured in the playbook, like Presbyterian, serve as a model for this important evolution of health care investment. These models showcase hospitals as an integrated member of their community and driver of an essential transformation of community health and wealth. This is a turning point for health care away from chasing after illness to generating health.”
— Stacia Clinton, Health Care Without Harm’s Healthy Food in Health Care program director
These projects include La Cosecha, Healthy Here Mobile Farmers Market, and the Wellness Referral Center (WRC). La Cosecha is a prime example of the partnerships between diverse stakeholders and health professionals that are improving food access for the community.
It was clear to Leigh Caswell, Presbyterian Center for Community Health director, that there was a natural connection between the health system and the CSA, which had been formed by the farmers with the intent of building community health and resilience.
“At Presbyterian, it is our purpose to improve the health of the patients, members, and communities we serve. Part of this mission is to help members of our community who face barriers in accessing basic supports needed for good health.”
— Leigh Caswell, Presbyterian Center for Community Health director
The formation of the Healthy Here Initiative in 2014 furthered the partnership between Presbyterian and Agri-Cultura. Healthy Here, with funding from the CDC REACH Cooperative Agreement, links several sectors of the local food system to increase health in priority communities — those with high rates of poverty, low educational attainment, and high percentages of Native American and Hispanic residents.
Changing menus — and lives
From June through October, La Cosecha participants receive weekly boxes of locally grown, organic produce. Shares feed four to six people and can be purchased with Supplemental Nutrition Assistance Program (SNAP) benefits. Full-pay shares cost $30 a week. Subsidized-pay shares are $6 per week. And participants can purchase half shares (both full-pay and subsidized-pay) for half price.
The program primarily serves low-income, native Spanish speakers living in the South Valley and the International District of Albuquerque. Eligible participants include families or individuals who self-report as low-income and meet the income eligibility guidelines for SNAP.
There are 17 partner organizations that serve as weekly distribution sites for the CSA, and each partner has different ways of identifying and engaging CSA participants.
Many of Presbyterian’s participants are referred through the Wellness Referral Center and can pick up at two of Presbyterian’s clinics. Operated by the Adelante Development Center, the WRC, serves Presbyterian Medical Group clinics as well as eight other clinics in Bernalillo County.
The center receives referrals from health care providers for patients with chronic health conditions like diabetes and heart disease, then connects them to relevant community-based programs and education on chronic disease prevention and management.
“It helps by bringing great nutrition and reducing the risk of diabetes and blood pressure…even hunger. We’re also trying to revitalize our area one turnip at a time”, says Joseph Alaro from Valle Encantado Farms.
Participating in the CSA has helped some members make lifestyle changes.
“We are eating healthier and cooking more — we stopped eating fast food,” says one participant in the program.
“Eating better made me want to exercise more. Eating in season just feels better,” another says.
La Cosecha also includes an education component, and each week the CSA shares are accompanied by a bilingual (Spanish/English) nutrition education handout that includes information about the farms, as well as nutrition tips, kid-friendly recipes, and storage guidance for that week’s produce. There are also in-person nutrition education sessions that include healthy cooking demos taught in both Spanish and English.
Receiving weekly bags of affordable, fresh, local fruits and vegetables — along with culturally relevant recipes and nutrition education — has participants excited about cooking and eating in new ways that benefit their health.
“Before, we rarely even kept fresh produce in the house…it has opened up my world to an entirely different way of eating and preparing food,” says one La Cosecha participant.
“I feel healthier and have more energy, and my family as well,” says another participant. “I have taught my grandchildren to eat healthier.”
The partnership between Presbyterian and Agri-Cultura is particularly effective in improving community health because it strengthens existing community-driven work and incorporates healthy, local food in health care delivery.
“Presbyterian has been there at the table as we determine how to best to serve the community’s needs,” Network. “We are developing a secure food system. The food is grown here, and stays here, and that has a big impact economically as well as on the health of our communities.” — Helga Garcia-Garza, co-director of the Agri-Cultura Cooperative
Amber Hansen is the Southwest Program Coordinator for Health Care Without Harm’s Healthy Food in Health Care Program.
