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Healthier Communities DRAFT Nutrition and Chronic Disease: Access to Health for All Developed in Partnership with Greater Grand Rapids Food Systems Council Spectrum Health thanks the VHA Health Foundation for their support in the development of this resource January 5, 2006 Spectrum Health Nutritional Options for Wellness (NOW) 75 Sheldon Avenue SE Grand Rapids, MI 49503 (616) 391-3990 Table of Contents Executive Summary .................................................................................................................. 1 Introduction ................................................................................................................................ 2 Hunger, Nutrition and Chronic Disease.................................................................................... 2 Economic Status Impacting Diet and Health .................................................................. 3 Social and Health Impact ................................................................................................ 3 The Burden of Chronic Diseases and their Risk Factors .............................................. 3 Causes of Hunger and Related Health Problems .......................................................... 4 Link between Hunger and Obesity .................................................................................. 5 What Kent County is Doing ........................................................................................... 7 Oversight Organizations ................................................................................................ 7 Waste Not Want Not ......................................................................................... 8 Kent County Check Up ............................................................................ 9 Service Gaps in Kent County ...................................................................................... 9 Issues Facing Kent County .................................................................................... 9 Current Efforts to Address Areas of Concern ............................................................... 10 Recommendations .......................................................................................................... 11 Nutrition and Health Education .............................................................................. 11 Availability of Healthier Food Choices ................................................................ 11 Encourage Sustainable School and Community Gardens ....................................... 12 Support Local Food Banks and Pantries ......................................................... 12 Assessing Food Pantry Transportation System (Commercial & End User) .............. 12 Evaluate the Nutritional Value of Available Foods ............................................. 12 Supporting Local Agriculture ................................................................................... 13 Developing Formalized Relationships with Wholesalers ........................................... 13 Conclusion............................................................................................................. 13 Works Cited .......................................................................................................................14 Additional Resources for Information .................................................................... 16 Tables: One: Risk Factors for Kent County and Michigan ................................................................ 4 Two: Diseases impacted by Nutrition ....................................................................................... 7 Appendices: A: Important Terms to Know ................................................................................................ 17 B: National Organizations Providing Food Redistribution ................................................... 18 C: Case Study of Kent County Emergency Needs Task Force Food Subcommittee Strategic Plan ........... 19 D: What People and Organizations Can Do To Help ........................................................ 21 Nutrition and Chronic Disease: Access to Health For All Executive Summary Purpose: To identify relationships between poverty, food insecurity, diet, and health in order to begin a community-wide dialogue about solutions. Exploring the connection between hunger, nutrition and chronic disease shows that economic status does impact the diet and therefore the health of our people. Problem: This document will identify the links between hunger, nutrition and chronic disease, primarily focused on Michigan and Kent County. The report will review how economic status impacts diet and health and the social and health impact this issue has on our communities. The burden of chronic disease and their risk factors will be discussed, in addition to the causes of hunger and related health problems. Further, the link between hunger and obesity will be outlined. Current Activities: Current activities taking place to address issues facing Kent County and current efforts to address areas of concern will be shared. Organizations and agencies that are working on hunger and nutrition issues will be outlined. Service Gaps: A brief assessment using the Waste Not Want Not project will be conducted to determine how Kent County is doing. Solution: Recommendations will be provided within this document to establish initial framework to spur innovative thinking, initiate discussion, and create synergy to improve the health and well being of everyone in our community. Resources: Under the Appendix sections, readers will have access to additional resource information such as glossary terms, food redistribution organizations, a case study of Kent County Emergency Needs Task Force’s Food Subcommittee Strategic Plan, and an outline of what people and organizations can do to help. Introduction Health-related problems stemming from food consumption have become increasingly commonplace in recent years. News media and academic journals alike have reported increasing instances of such health problems as obesity, diabetes, and heart disease. Nutritionally inadequate diets based on high-fat, high-sugar, empty-calorie foods are a critical factor in the vast majority of these chronic diseases. The highest rates of such health problems occur in populations facing economic difficulties. Recent research shows that the lack of quality food in a diet often correlates with poverty and poor health. This report draws definite linkages between economic hardship, diet, and health in order to expand community awareness and initiate community dialogue. Focusing on the relationship between hunger, nutrition and some chronic diseases, this paper will draw from statistical information which indicates how economic status can impact diet and how both impact overall health. In addition to providing information about what Kent County is currently doing, the report will identify gaps in current services and provide recommendations for use as a framework for businesses, public-sector agencies, non-profit organizations, and community members to address those gaps. Hunger, Nutrition and Chronic Disease Hunger can be defined as "the uneasy or painful sensation caused by a recurrent or involuntary lack of food,” (FRAC, 2003) and is a potential although not necessary consequence of food insecurity. Food insecurity and hunger is measured by the U.S. Department of Agriculture, using a nationally representative survey about behaviors and experiences related to food insecurity. Survey questions identify whether individuals worry about running out of food, skipping meals, or eating balanced meals or having to eat less than they should. The severity of the responses reflects the degree of food insecurity or hunger in the household. Hunger impacts more than 30 million Americans annually, and the number continues to grow each year. In fact, 2003 saw an increase of hungry and food-insecure Americans over the four years since 1999, up to 36.3 million people. (Vollinger, 2004). At the same time, a trend to greater obesity rates compounds and complicates hunger-related problems, resulting in increased instances of heart disease, diabetes, and other chronic problems in persons suffering from economic hardship. A lack of appropriate, high-nutrition food sources in the diets of low-income populations would seem to be the culprit. Currently, many food pantry systems (see Appendix A for definitions of important terms), including the one in Kent County, focus on providing food for hunger. Second Harvest Gleaners of West Michigan (Gleaners) and the Kent County emergency food system have worked tirelessly to meet the demand for feeding the hungry, trying to supply all of their basic food needs, and are to be commended for their great success to date in increasing the access of low-income people to food. However, Gleaners and the pantry system rely heavily on food donations. Often, these donated food items are highly processed foods high in salt, sugar and fats. Those very same food items have been shown to increase the risk of chronic conditions such as diabetes, high blood pressure and heart disease. While hunger is still—and increasingly—an issue, it is necessary to provide poverty populations with healthier, more nutritious foods that address specific health needs of the chronically ill and those at high risk for developing chronic illnesses. Economic Status Impacting Diet and Health As of September 2005, close to 8.9% (50,904) of Kent County’s residents live below the poverty line and nearly a quarter of its residents (135,110) live at 200% below the poverty line (MPCA, 2004). The Kent County Behavioral Risk Factor Survey, which examines demographic factors such as economic status and their impact upon health, indicates that 12.9% of Kent County residents are in poor health (Kent County Health Department, 2002). See Table One below for more information. Further, 39.3% of Kent County’s residents worry about securing basic necessities, such as food, clothing, and shelter (VanIwaarden, 2001). And Kent County’s unemployment rate hovers around 6.3%, which is higher than the national average of 5.9% (Campbell, 2005). Social and Health Impact Chronic diseases such as diabetes and heart disease are the most common and expensive health problems, and yet in many instances they are preventable (Chronic Disease Overview, 2004). To compound this issue, diabetics who are defined as “hungry” averaged more calls and visits to the doctor than those diabetics who are not hungry. The study stated that these calls and visits contribute to the “$7.7 billion a year in direct medical costs among the 5% of the population with diabetes” (Center for the Advancement of Health, 2001). Some of the leading disabilities of persons 15 and up are caused by chronic conditions such as high blood pressure and diabetes. The CDC reports that 70% of all US deaths are caused by chronic disease. Further, one out of every ten Americans experiences the limitations of activity and movement, pain, and decreased quality of life that result from extended illness and disability. Alarmingly, “heart disease is the leading cause of death for American Indians and Alaska Natives, blacks, Hispanics, and whites. Although cancer is the leading cause of death for Asians and Pacific Islanders (accounting for 26.1% of all deaths), heart disease is a close second (26.0%). Heart disease was projected to cost $393 billion, including health care services, medications, and lost productivity in 2005”. It is disturbing to note that in 1998, African-American adults had a 30% higher rate of death from cardiovascular disease than white adults (Cardiovascular Health, 2005). The Burden of Chronic Diseases and their Risk Factors As long ago as 1988, the Surgeon General’s Report on Nutrition and Health acknowledged the relationship between diet and ill health. “Diseases such as coronary heart disease, stroke, cancer and diabetes remain leading causes of death and disability in the United States. Substantial scientific research over the past few decades indicates that diet can play an important role in the prevention of such conditions.” Since chronic illness is so prevalent and incurs such high costs at the community and state levels, it is critical to identify the risk factors associated with chronic disease. Risk factors identified in the 2002 Behavioral Risk Factor Survey (BRFS) for Kent County are provided in Table One. The figures show residents’ self-perception of fair or poor health, reflects the number of residents that eat five fruits or vegetables a day and participate in physical activity. In addition, the table also shows that more Kent County residents are diagnosed with diabetes than respondents in the national BRFS study. Low socioeconomic status resulted in a higher prevalence of heart disease, stroke and obesity in Kent County (BRFS, 2002). Data percentages identified in the table are also representative of Michigan (Behavioral Risk Factor Surveillance System, CDC, 2002) are also identified in Table One. Table One: Risk Factors for Kent County and Michigan Region Fair or < 5 fruit Diabetes % heart No Obesity Stroke Poor and veg’s. disease Physical health Activity 12.9% 89.9% 7.2% 6.5% 20.3% 19.6% 3.3% Kent County Michigan 13.5% 79.9% 8.1% 7.1% 24.3% 26% 3.9% These factors shed light on the health status of persons in low income brackets, especially those making less than $20,000 a year, even more dramatically than current county and state statistics. The percentage of respondents reporting fair or poor health increases to 35.4% for those with an average household income of less than $20,000. Moreover, a similar trend appears for physical activity, with 40.1% of respondents reporting no leisure-time physical activity. Heart disease statistics also show a sharp increase to 16.3% for this demographic group, and the same trend follows for obesity at 25% and stroke at 8.7% (BRFS, 2002). The 2001 Hunger in Michigan Report paints a statistical picture revealing much about hunger and health in West Michigan (Myoung, 2001). 36.1% of the persons serviced by the Second Harvest Gleaners in West Michigan are under 18 years old, with 12.5% under five years old. 54% of the clients served by the Second Harvest Gleaners are white, 37.4% are African American and 4.9% are Hispanic. Fully 31.8% of Second Harvest Gleaners' clients reported at least one family member to be in poor health (Michigan Report, Myoung). Another local group in Kent County, ACCESS (All County Churches Emergency Support System), plays an important role in helping underprivileged persons meet their dietary needs. In fact, ACCESS assists over 5,500 households each month, 8% of the county’s total population. Of the households served (2004), close to one-third were new to the system. Over 50% of the households serviced by ACCESS survive on incomes below $10,000 a year. Moreover, 47% of families served by ACCESS have dependent children, and of that percent, only 20% are two-parent households. ACCESS food distribution programs serviced over 162,000 children in 2004. 37% of ACCESS clients are white, 22% are African-American, and 15% are Hispanic (DeHollander, 2005). The work of these and other emergency-food-provision agencies has helped to combat many problems associated with socio-economic strife, hunger, and diet. However, concerned groups and citizens must also understand the roots of hunger and how living below the poverty level can worsen health problems before effective solutions can be developed and implemented. Causes of Hunger and Related Health Problems The growing hunger trend within the United States can be attributed to numerous causes. However, the recent weakness of the economy has certainly increased the enormity of the problem. According to Sherman (2004), "[a]lmost certainly the key cause of the worsening of the situation from 1999 to 2003 was weakness in the economy for the bottom half of Americans—wage stagnation, joblessness, and underemployment." Federal programs have helped to alleviate some of the associated problems, but by and large these efforts have had minimal impact on emergency food demand. According to the report From the Farm to the Table, “While the average American's food costs are relatively low compared with other developed nations, food is often the most expendable item on a person's budget. Low level entry wages, especially for former welfare recipients, are often not enough for rent, utilities, clothing, transportation and food” (2005). Low-income families often have to choose between food and other necessary resources. The 2001 Hunger in Michigan Report states that 36.3% of clients had to choose between purchasing food and paying for utilities (2001). In fact, the study found that of the emergency food clients surveyed, 70% live below the poverty level and 41% live in households with someone who is in poor health. (National Report, Myoung). This statistic helps to show the correlation between economic standing and poor health; individuals, as a direct result of their low economic status, cannot afford to make healthful dietary choices. A survey conducted by the National Center for Health Statistics reports, “Diabetics who did not have enough to eat due to financial constraints were more than twice as likely to report having poor or fair health than those who did not go hungry” (2005). This is complicated by the fact that those in poverty often also lack the financial resources for regular visits to the doctor. In fact, 30% of the emergency clients served by America’s Second Harvest reports having to choose between paying for food and paying for medicine or medical care (National Report, Myoung, 2001). Link between Hunger and Obesity Inner city lower-income residents are often limited in their shopping choices due to lower rates of car ownership and other factors that limit physical mobility. Often, poverty is concentrated in areas where there are very few or no grocery stores. Shoppers are often forced to buy food at nearby “corner stores” whose limited selection and higher prices limit their healthful purchases. Prices for fresh fruits, vegetables, and meats are sometimes up to 24% or more at these stores than suburban grocery stores, which can act as an incentive to the purchase of less nutritious foods which are generally cheaper. This tends to favor less nutritious foods, and health and quality of life for these people is often greatly impeded. The eating habits of people facing economic hardship can lead to a variety of health problems in young and old alike. Because they tend to emphasize food quantity over quality, many may eat high calorie foods to maximize nutritional value. Generally, foods that are more dense nutritionally, which are often the more expensive foods, promote greater feelings of fullness. Food-insecure populations may therefore eat greater quantities of high-calorie, less expensive foods – “junk” foods – to achieve that desired fullness. Hungry persons may overeat when food becomes available, prompted by psychological factors associated with constant food insecurity. Moreover, emergency food providers may inadvertently add to the problem by giving clients food just “to fill their bellies” (The Paradox of Hunger and Obesity in America, 2003). Poor diets also impair the cognitive function in growing children, and have been linked to behavioral problems such as Attention Deficit Disorder. Lead poisoning in children is heavily concentrated in lower-income areas where environmental exposures (for example, peeling paint in older homes) cannot be avoided. According to The Advisory Committee on Childhood Lead Poisoning, though it does not recommend dietary intervention as a top strategy, “Adequate iron and calcium stores may decrease lead absorption, and vitamin C may increase renal excretion” (2005). According to experts, many chronic health problems, such as obesity, heart disease, diabetes, and stroke, can be prevented by access to adequate diets and healthier lifestyle practices. A wide variety of fruits and vegetables consumed in conjunction with a balanced diet and exercise can help to ward off a variety of health problems. According to recent US Census Data, 77.4% of Michigan residents do not consume adequate servings of fruit and vegetables each day. Moreover, “82% of men and 72% of women reported eating fewer than five servings of fruits and vegetables per day and 81% of students ate fewer than 5 servings per day of fruits and vegetables” (The Burden of Chronic Diseases and Their Risk Factors, CDC, 2002). Fruits and vegetables with rich vibrant greens, oranges, yellows, and reds especially contain a variety of nutrients necessary to the vital functioning of various body systems, especially the immune system. Such diets also help to reduce cholesterol and lower blood pressure. In fact, the Harvard School of Public Health elaborates by stating, “the higher the average daily intake of fruits and vegetables, the lower the chances of developing cardiovascular disease” (2005). It is important to mention that individuals can maximize their health and nutritional benefit from the fruits and vegetables they eat by choosing produce at peak ripeness. Locally grown and harvested produce is typically at its peak nutritional value when it is ripe. Fruits and vegetables that are shipped far distances are picked before they are ripe. Unfortunately, the produce gets its nutritional value from the stem of a living plant. In addition, there is a large body of research indicating that the closer to the point of fresh-picking fruits and vegetables are, the more nutrients they contain. Investigations by researchers in the European Union showed that nutritional acids and fatty acids and complex sugars decline post-harvest and continue to decline until the fruit spoils. Thus, once it is harvested, a fruit or vegetable’s nutritional value actually decreases every day that passes between harvest and eating. Spectrum Health Nutritional Options for Wellness (NOW) program recently worked with two dietitians to identify nutritional connections and goals as they relate to common chronic illnesses. See Table Two for additional information. Moreover, it is suggested that insufficient nutrient intake accounts for a disproportionate amount of health care costs among low-income elderly individuals, unrelated to the aging process (Weimer, 1998). All of these health problems cause other hidden costs, including increased health care spending and decreased productivity. Each year, 1.4 trillion is spent on the nation’s annual health care costs, and close to 75% of this cost can be attributed to preventable, chronic diseases. People suffering from chronic disease comprise the fastest growing segment in health care and incur the highest costs to society. Annually, $129 million dollars in expenses are incurred due to lost productivity caused by heart disease. (Chronic Disease Overview). The direct and indirect costs of diabetes, reported in 2005, amount to nearly $132 million per year. According to the Center for the Advancement of Health, “it may be more cost-effective to ensure food security to this population than to provide additional medical services” (2005). Table Two: Diseases impacted by Nutrition (Pereira, 2005) Disease Nutrition Connection Nutrition Goals Diabetes Prevention through balanced diet Meals with moderate carbohydrate, low fat, high without excesses and monitoring fiber foods. May also need a low sodium meal plan glucose if already affected Pancreatitis Treatment is to alleviate Balanced, low fat diet symptoms Open Wound For proper healing A diet with adequate calories including foods high in protein, vitamin C and zinc, fresh fruits and vegetables COPD To diminish body burden Require extra calories and may benefit from moderate carbohydrates. Need a good source of protein at each meal Cardiovascular Prevention and treatment Low fat, simple sugar, low sodium, high fiber diet Renal Prevention of worsening Diet varies depending upon severity of disease. May symptoms and damage to kidney, need to limit sodium, protein, potassium, prevention of death phosphorus While malnutrition among the needy has negative economic, social and physiological impacts on individual and community development, numerous national and regional organizations are working to alleviate the problem. What Kent County is Doing More than 744,000 different people in Michigan received food through the Michigan food-banking network in 2001. Half of those are the very young or the very old, the most vulnerable residents of our state (Michigan report, Myoung, 2001). There are several organizations in Michigan and Kent County that are working tirelessly to address hunger. Oversight Organizations The Food Bank Council of Michigan is a statewide organization which has provided help for Michigan residents suffering from hunger or food insecurity. In fact, this organization helped to donate over 75 million pounds of emergency food and related items in 2004 alone. The council also supplies food and funding to food banks across the state. Food Bank Council of Michigan consists of six regional food banks, including Second Harvest Gleaners of West Michigan, and other emergency food providers, including food kitchens, pantries, and senior meal programs. Second Harvest Gleaners of West Michigan is a food bank, founded in 1981, which serves as West Michigan’s regional nonprofit clearinghouse for food donations to churches and charities. This one organization serves close to half of Michigan’s 80 counties, supplying close to 70,000 pounds of food per day to over 1,100 agencies statewide (the third highest of any food bank in the U.S.). The Kent County Emergency Needs Task Force (ENTF) is a non-profit oversight body that has existed since 1982 and works with community leaders, organizations, and concerned citizens to monitor basic service systems in Kent County, such as shelter, utilities, transportation and food. Subcommittees that participate in developing an annual report that assesses community needs, overall publicity and long-range planning to meet emergency basic needs address each basic service. The ENTF Food Subcommittee has worked extensively throughout the community to provide food resources and nutrition education, especially through innovative programs such as the Summer Family Food For Thought program, which helped 204 families meet nutritional needs during summer break in a more family-centered education-based way. The ENTF Food Subcommittee’s purpose is to conduct the assessment of acquisition, storage, and distribution of food and related support services, and to coordinate access of all Kent County residents to food. ACCESS is a network of 350 Kent County churches that work together to help provide support services, including food pantries, for many of the county’s most economically disadvantaged families and individuals. ACCESS helps to oversee the Food Pantry Network of Kent County, a referral system of 100 pantries. This system helps to coordinate new pantry staff, food drive organizations, volunteer recruitment and training, computer maintenance, and the Holiday Giving Network Program. Another program, ACCESS CARES, also provides skills for living classes and assistance. Waste Not Want Not In September 2004, Second Harvest Gleaners of West Michigan released an action agenda titled Charity Food Programs That Can End Hunger in America. The report provides a background for ending hunger in America, using research that was conducted from 1994 through 1996. The research was conducted by two dietitians and was accomplished in through a partnership involving Second Harvest Gleaners of West Michigan, Michigan State University and United Way. The research project, Waste Not Want Not (WNWN), looked at the vast range of practices found within the charity food distribution system to discern how improvements could be made to meet needs more broadly, efficiently and effectively (Appendix B). The findings reported that average communities have enough resources to end hunger five times over, but are probably only meeting a minimal amount of need due to resource utilization. The report offered a scoring system that could assist pantries in determining if improvements are needed and suggestions to begin the process of improvement. Some suggestions offered by the report include: client choice pantries, allowing more frequent visits to pantries, and less stringent client registration requirements. Arnold (2005) stresses that focusing on ending hunger requires allowing all donated items, without judgment, onto a pantry’s shelves. Further, the report recommends “that only after you are certain that everyone who is hungry has enough to eat are you willing to begin refining that food supply to accommodate non-hungry people’s notions of what is ‘good’ food or ‘bad’ food.” Finally, the research provided helpful methods that communities could use to estimate the need that exists, using a formula that multiplies the number of people in the community with income at or below poverty level times 234 pounds. The total is representative of a community’s annual charity food assistance poundage needs. The reports advocates that this method of estimation “simply recognizes that poverty and hunger keep close company and at approximately this ratio of people to need” (Arnold, 2005). Kent County Check Up ACCESS formally changed their service policy after the initial WNWN report. The Kent County food pantry system subsequently began to implement many of the WNWN recommendations to improve existing services. Pantries began to switch to client choice, the registration process for clients became less restrictive, and the frequency of visits was increased. The ENTF Food Subcommittee developed a three-year strategic plan in 2004 to address the next generation of food assistance issues in the county (See Appendix C). The strategic plan focused on broader issues such as transportation, food security, client self-sufficiency and food self-reliance, outreach, nutrition, food-related health issues and increasing the financial and resource support for food assistance programs (ENTF Memo, July 2005). The participants in the strategic planning session believed this was an appropriate plan of action, as the United Way’s 211 Unmet Needs Report and other measures reflect that the emergency food assistance need is largely being met. When the Charity Food Programs That Can End Hunger in America report was released in September 2005, the Food Subcommittee decided that it would be helpful to use the information and methods of assessing existing need to gauge Kent County’s progress of improvement. The subcommittee used poundage as a measurement for utilization and access of food benefit/stamp dollars, WIC benefits, ACCESS Pantry Services, Second Harvest Gleaners of West Michigan, free meal lines and food delivery services (God’s Kitchen, Kids food baskets, TFAP, etc.). They found that the total of pounds provided in Kent County was 40,900,953. Using the WNWN formula for estimating need, the subcommittee divided that number by the number of persons in poverty (49,832). The results, 820 pounds per person, show that Kent County has met and indeed surpassed the amount of pounds of food per person in poverty suggested in the WNWN report by 586 pounds (ENTF Memo). Since there is still reported hunger in Kent County, this statistic casts some doubt on the viability of using 234 pounds as a guide; the ENTF Food Subcommittee continually seeks to improve its delivery of food to those in need. However, provision of this large amount of food does reinforce the subcommittee’s resolve that emergency food providers have reacted appropriately to the WNWN research recommendations to meet hunger needs. The subcommittee will continue its efforts to meet the needs of the hungry, but also pledges to work diligently to resolve “long term issues around client poverty such as transportation, food security, nutritional and health issues, outreach and self-sufficiency” (ENTF Memo). Service Gaps in Kent County While Kent County has many organizations that are working conscientiously to address issues impacting hunger, nutrition and chronic illnesses, there are existing gaps that limit capacity. This section will identify some of the issues, as well as fledgling efforts to address some of them. Issues Facing Kent County Concerns facing the Kent County Emergency Food Distribution System include: transportation distribution, storage capacity, providing culturally appropriate foods, and the growing number of seniors. Many pantries speak of missed opportunities to obtain food due to space, time or transportation issues. Often food donations are offered directly to food pantries in amounts that are too large for individual pantries to transport, largely due to pantries’ reliance on volunteer vehicles. For example, if food is offered in skids only, a small car is not going to be effective in obtaining the offered foods. Time is also an issue. Because many pantries are led or staffed by volunteers, often food cannot be picked up when it needs to be and the opportunity is lost. There is also a limited capacity for storage, which is particularly applicable to fresh local food donations. This is sometimes a need for greater refrigeration capacity, and sometimes a larger issue with the overall size of pantry accommodations. Food pantries also express a desire, though limited by capacity, to meet the nutritional needs of individuals based on our community’s growing diversity. This would necessitate providing foods that are culturally appropriate for various ethnicities. Pantries are also aware of the increased demands of pantry usage that will result from newly displaced workers and a growing population of seniors that will be needing pantry services as the cost of living, medical expenses and medications continue to rise and challenge their budgets. In addition, individuals from our community often know they should eat healthier, but what does that mean and what does that look like? Does the average citizen know what healthier food choices are and how that impacts their health? And greater questions remain. Are they able to access the healthier foods? If they can access the food, do they know how to cook healthier foods or make what they are already eating healthier? Further, do they know how to preserve fresh foods for longer food sustainability? Our challenge, as a community, is to provide answers to these questions. Current Efforts to Address Areas of Concern To address transportation distribution issues, Kent County Emergency Needs Task Force Food and Transportation Subcommittees, Grand Valley State University and Nutritional Options for Wellness (NOW) program are working together to identify partners that can assist in conducting a transportation assessment of the Kent County Food Pantry System. This assessment would serve to identify existing resources throughout the pantry system and provide recommendations that would maximize those resources and eliminate duplication. This will increase the pantries’ ability to serve others and open opportunities to provide a wider variety of foods to pantry clients. Spectrum Health is working with food pantries to offer their clients cooking classes and health screenings. Food pantry recommendations have been made and distributed to the food pantries to raise awareness of the food needs for specific illnesses impacted by nutrition. This fall bookmarks will be provided to food pantries, which can be distributed to pantry clients to provide health information and tie in the importance of proper nutrition. Michigan State University Extension has curricula in place to educate the community in the art of food preservation. However, there are no funds available to support a position and the cost of supplies. Herein exists an opportunity for businesses, organizations and programs to support this effort and disseminate this education to the community at large. Other community efforts taking place to increase lower-income residents’ access to healthy food include developing a flyer of web site resources for information on food preservation; partnering with Project TakeOff (a local obesity initiative); providing health promotion opportunities at local farmers’ markets; use of electronic food stamp cards at the large Grand Rapids farmers’ market; and creation of healthy school gardens, while a broader community garden promotion and facilitation program, with a special emphasis on low-income gardeners, is just underway. Recently, Michigan Food & Farming Systems and Greater Grand Rapids Food Systems Council developed West Michigan FRESH: A Guide to Local Food, 2005. The guide provides a list of resources for locally-raised food, including farmers, restaurants, caterers, retail stores, and farmers’ markets—designating the markets eligible to take Project FRESH coupons. Recommendations As stated in the executive summary, this report has examined the connection between hunger, nutrition and chronic disease, showing the impact economic status has on diet and therefore health. The recommendations are not intended to be all-inclusive but are suggestions to spur innovation, creative thinking, begin discussion, and initiate synergy to improve the health and well being of everyone in our community. Nutrition and Health Education 1. Provide health and nutrition education at local farmers’ markets, at community and/or school gardens, and through existing health education outlets. 2. Conduct taste-testing events, cooking demonstrations and health screenings at neighborhood outlets including small grocery and corner stores, restaurants, and farmers’ markets. 3. Offer food preparation and education events (such as food preservation) within the community, especially at community festivals and events, to create demand for more nutritious food. 4. Introduce youth to healthy eating through farmers’ markets in schools, giving credit for community service hours to volunteering at farmers’ markets, and encouraging job opportunities in fields that promote healthy food. 5. Encourage community and government organizations to model appropriate nutrition and use of fresh local food at public events. 6. Target neighborhood associations with large food-insecure populations with information about the relationship between diet and health, and encourage the creation of action plans to address the problem. 7. Explore promoting healthy eating and consciousness of lower-income diet and health needs through Chamber of Commerce. Availability of Healthier Food Choices 1. Increase the availability of fresh local food at corner stores and neighborhood restaurants by connecting farmers in the area with local small business owners. 2. Assist small grocery and corner stores with selling more local produce at a lower cost, and encourage local and state legislators to provide incentives for doing so. 3. Create, support and promote entrepreneurial opportunities that promote access to healthier foods, such as sales of produce grown in community or backyard gardens or small-scale home delivery from farmers’ markets. 4. Encourage local health care institutions to work with Grand Valley State University’s Community Research Institute and ACCESS to conduct a shared GIS mapping that will illustrate where food is available and where the high-risk chronically ill population is living. 5. Develop training opportunities for individuals, such as seniors and WIC recipients, on how to use EBT technology to increase utilization of WIC and Project Fresh resources. 6. Develop policy to expand Project Fresh coupon availability and eliminate administrative barriers to Senior Project Fresh. 7. Develop busing from low-income neighborhoods and centers to local grocery stores to promote independence and increase economic growth, as well as encouraging neighborhood walkability paired with neighborhood grocery store development. Encourage Sustainable School and Community Gardens 1. Establish a countywide program to initiate new community gardens and support and enhance existing community gardens to help meet food needs of lower-income citizens, including policy change where necessary. Encourage Master Gardeners to donate their time and expertise to community gardening in lower income neighborhoods. 2. Support the existing school and community gardens program through volunteer efforts and donations. 3. Donate excess foods from school and community gardens to local food pantries. Support Local Food Banks and Pantries 1. Increase community awareness of and create leadership for a Grow-a-Row initiative, which encourages farmers and gardeners to plant small areas specifically for donation to food banks and pantries. 2. Continue and expand existing physical-gleaning or field-harvesting programs, in which volunteers harvest excess produce at farms and gardens. 3. Encourage “sister congregations” (this is a situation in which an inner-city church is paired with a suburban or exurban one) to maintain food gardens and donate their produce to local food banks and/or pantries. 4. Request that participants in food drives donate healthier non-perishables, such as low/no sodium vegetables, fruits packed in their own juices or water, high fiber, low fat items. 5. Establish a fund that encourages monetary donations that enables food pantries to purchase difficult-to-maintain food items such as lean unsalted meats and locally-grown fruits and vegetables. 6. Identify areas that could benefit from inclusion on the Second Harvest Gleaners mobile produce truck route, and find financial assistance to make that a reality. Assessing Food Pantry Transportation System (Commercial & End User) 1. Assess the transportation system as it relates to distribution of nutritious food to lower-income residents, and take advantage of existing charitable transportation services to increase cost-effectiveness and eliminate duplication. Evaluate the Nutritional Value of Available Foods 1. Conduct food inventory of the pantry system and low income neighborhood grocery stores to evaluate impact that available foods can have on overall health prevention and maintenance. 2. Expand nutritional labeling on prepared meals at kitchens as is already underway with Senior Meals. 3. Promote local wellness policy. Consider local government adoption of a food charter that would institutionalize the provision of healthy foods to the food-insecure population. 4. Assist with and implement schools’ “local wellness policies” by encouraging inclusion of nutritious foods and beverages in food service, and by mandating nutrition education at all levels. Supporting Local Agriculture 1. Support economic success of local farms to ensure continued sources of food highest in nutritional value. Developing Formalized Relationships with Wholesalers 1. Develop stronger, more formalized relationships between distributors of healthy foods and food banks/pantries. Most importantly, start a community dialogue to develop and refine recommendations, ask questions, and translate the answers into action. To identify additional strategies that organizations can implement, review ideas and tips that were outlined by the USDA Summer of Gleaning Project., see Appendix D). Conclusion Health-related problems resulting from food consumption have a far-reaching impact on the community, both economically and socially. In many instances chronic conditions are preventable and manageable with appropriate nutrition. It is up to the community to ensure that those facing economic difficulties have access to high-quality nutritious diets, reducing both the human suffering associated with chronic disease and the very high health-care costs associated with chronic conditions. This report has demonstrated linkages between poverty, health, and diet in an effort to build awareness and instigate dialogue. People’s economic status can and does impact their diet and overall health. Community-wide thinking, discussing, strategizing and planning coupled with a commitment to improvement can ultimately result in a significant shift from providing food solely for hunger to providing food for nutrition, and help make the epidemic of diet-related chronic disease in poorer populations a thing of the past. Works Cited A Citizen’s Guide to Food Recovery. United States Department of Agriculture (USDA). Retrieved on October 2004 from www.usda.gov/news/pubs/gleaning/htm. Arnold, John. (September 2005). Charity Food Program that can end Hunger in America. Second Harvest Gleaners of West Michigan. Behavioral Risk Factor Surveillance System. Center for Disease Control (CDC). Retrieved on October 2002 from www.cdc.gov/brfss/. Koop, C., et al. (1988). Surgeon General’s Report on Nutrition and Health. U.S. Surgeon General. Campbell, M. (April 21, 2005). March Jobless Rates Decline in All of Michigan's Major Regional Labor Markets; Most Regional Rates Down Over Year. State of Michigan Department of Labor and Economic Growth. Retrieved March 2005 from www.michigan.gov/mdcd/0,1607,7-122-1683_2858-116156-M_2005_1,00.html. Cardiovascular Health. National Center for Chronic Disease and Prevention (CDC). Retrieved on December 2005 from www.cdc.gov/cvh/library/fs_heart_disease.htm. Chronic Disease Overview. National Center for Chronic Disease and Prevention (CDC). Retrieved on October 2004 from www.cdc.gov/nccdphp/overview.htm. DeHollander, M. (October 2005). Interview. All County Churches Emergency Support System (ACCESS). Diabetes: Disabling, Deadly, and on the Rise. (May 2005). National Center for Chronic Disease and Prevention (CDC). Retrieved on October 2005 from www.cdc.gov/nccdphp/publications/aag /ddt.htm. ENTF Action Plan 2004-2005. (September 2004). Kent County Emergency Needs Task Force Food Assistance Subcommittee (ENTF). From the Farm to the Table: Making the Connection in the Mid-Atlantic Food System. Clagettfarm.Org. Retrieved January 2005 from www.clagettfarm.org/foodaccess.html. Fruits and Vegetables. Nutrition Source, Harvard School of Public Health. Retrieved on July 2005 from www.hsph.harvard.edu/nutritionsource/Printer%20Friendly/Fruits%20and%20 Vegetables.pdf. Kent Co. Behavioral Risk Factor Survey. (2002). Kent County Department of Health (KCHD). Retrieved on February 2004 from http://www.healthykent.org/brfs02.pdf. Kent County Emergency Needs Task Force 2002-03 Update Report. (July 2003). Kent County Emergency Needs Task Force (ENTF). Lack of Access to Food Linked to Increased Medical Utilization Among Diabetics. (July 1, 2001). Center for the Advancement of Health. Retrieved June 2005 from http://www.hbns.org/ newsrelease/lack6-01-01.cfm. Lead Exposure in Children: Prevention, Detection, and Management. (October 2005). American Academy of Pediatrics. Retrieved November 2005 from www.pediatrics.org/ cgi/content;full/116/4/1036. Medicine or Food. America’s Second Harvest. Retrieved on April 2004 from www.secondharvest.org/site_content.asp?s=148. Memorandum. July 2005. Kent County Emergency Needs Task Force Food Subcommittee (ENTF). Myoung, K., Ols, J., and Cohen, R. (October 2001). Hunger in America 2001 Michigan Report. America’s Second Harvest. Retrieved on July 2004 from www.fbcmich.org/Michigan-Report.pdf. Myoung, K., Ols, J., and Cohen, R. (October 2001). Hunger in America 2001 National Report. America’s Second Harvest. Retrieved on July 2004 from www.hungerinamerica.org/ site_content_asp?s=81. Pereira, R. and O’Neill, P. (March 2005). Diseases Impacted by Nutrition. Spectrum Health HeartReach Program and Spectrum Health Marywood Diabetes Center. Primary Health Care Profile of Michigan. The Michigan Primary Care Association (MPCA). 2004. www.mpca.net/healthpolicy/profiles.htm. Richard J. Bringewatt. (1998). Healthcare's Next Big Hurdle. Healthcare Forum Journal . Sherman, Arloc. (December 20, 2004). Hunger, Crowding, and Other Hardships are Widespread Among Families in Poverty. Center on Budget and Policy Priorities. Retrieved January 2005 from www.cbpp.org. The Burden of Chronic Diseases and Their Risk Factors. National Center for Chronic Disease and Prevention (CDC). Retrieved May 2004 from www.cdc.gov/nccdpahp/burdenbook 2004/index.htm. The Paradox of Hunger and Obesity in America. (July 2003). Center on Hunger and Poverty in America. Food Research and Action Center (FRAC). Retrieved April 2004 from www.centeron hunger.org/pdf/hungerandobesity.pdf. VanIwaarden, D. (September 2001). 2001 Greater Grand Rapids Community Survey Results. Community Research Institute, Grand Valley State University. Vollinger, E. and Weill, J. (November 19, 2004). New USDA Food Insecurity Numbers Released. The Food Research and Action Center (FRAC). Weimer, J. (October 1998). Factors Affecting the Nutritional Intake of the Elderly. Food and Rural Economics Division of the United States Department of Agriculture. Retrieved on July 2005 from www.ers.usda.gov/publications/AER769/index.htm. Additional Resources for Information ACCESS Food Pantry Program of Kent County http://www.accessconnects.org/default.htm Food Bank Council of Michigan http://www.fbcmich.org/ Kent County Emergency Needs Task Force Food Subcommittee, Terry Cruzan Co-chair Food Committee Salvation Army 1215 E. Fulton Grand Rapids, MI 49503 Second Harvest Food Gleaners Bank of West Michigan http://www.wmgleaners.org/ “Tax and Financial Benefits of Contributions to Food Banks” Can be found in “A Citizen’s Guide to Food Recovery.” USDA. 2004. Appendix A: Important terms to know Following is a list of terms that might prove helpful to those wanting to learn and understand more about the topics covered in this report. (A Citizen’s Guide to Food Recovery, 2004). .1. Field gleaning: .The collection of crops from farmer’s fields that have already been mechanically harvested or on fields where it is not economically profitable to harvest. 2. 2. Perishable food rescue or salvage: The collection of perishable produce from wholesale and retail sources. .3. Food rescue: .The collection of prepared foods from the food service industry. Non-perishable food collection-especially the collection of processed foods with long shelf lives. .4. Food bank: A food bank provides a tax deductible, convenient and safe donation outlet for surplus items, .misprints, shortfalls, seasonal items, promotional items, customer refusals, overbakes and discontinued food items (Fbmich.org). .5. Food pantry: .A service for individuals that provides purchased and donated non-perishable food items to assist individuals in meeting their nutritional needs. 3. 6. Community and school gardens: Community Gardens are planned and organized by various groups, enabling individuals to supplement their food supply by growing some of it themselves. Such gardens can be designed for the low-income or more affluent community growers allowing them to participate in plan a row efforts. Community gardening improves the quality of life for people, and offers social interaction, self- reliance, and provides nutritious food thereby reducing budgets. It also provides opportunities for recreation, exercise, therapy, and education. 7. Farmer’s Markets: Farmers' markets are usually held out-of-doors, where farmers can sell their produce to the public. Products at such markets are renowned for being, very fresh, and sold directly to the public. Farmers' markets often feature additive-free products and produce. Appendix B: National Organizations Providing Food Redistribution The Summer of Gleaning Article states that more than 10% of the US population depends on non-profit food distribution for a significant part of nutritional needs. Futher, A Citizen’s Guide to Food Recover reports that this number is rising due to reduced food stamp allocations, higher unemployment rates, and high senior populations ( 2004). .1. AmeriCorps National Service Program: A domestic national service program involved in anti-hunger programs, including gleaning and food recovery, in five urban and rural areas across the county. For more information please see .http://www.americorps.org/. Also, please see article “How the USDA AmeriCorps Summer of Gleaning Worked” which is in the USDA Summer of Gleaning packet. .2. St. Mary’s Food Bank: .Founded in 1967, this organization helped to pioneer food recovery programs in the United States. For more information, please visit http://www.smfb.org/. 2. 3. America’s Second Harvest: This organization is the largest domestic charitable hunger relief organization in the United States, providing emergency food relief to 26 million people each year. For more information, please visit www.secondharvest.org/. Appendix C: Case Study of Kent County Emergency Needs Task Force Food Subcommittee Strategic Plan Kent County Emergency Needs Task Force Food Subcommittee (ENTF) held a strategic planning session with experts in the community serving as participants in the planning process. Participants worked in various sectors such as emergency food delivery, school systems, a regional gleaner, community programs, local food systems council, United Way, faith based programs, government departments and Family Independence Agency. The result was a strategic plan that focused on a system’s approach that demands that there are specific food needs for various populations. This included supporting access to food issues outside of the emergency food delivery system, which made initiatives such as community gardening and farmer’s markets more inclusive to their efforts. In addition, the work to be completed had a more wholistic approach for the individuals being served at the food pantries in our county (ENTF 2004). Outline of ENTF’s Action Plan, 2004-2005 The ENTF Food Subcommittee’s mission is to ensure that all people of Kent County have access to safe, adequate, affordable, and nutritious food. The ENTF Food Subcommittee has worked to identify the most pressing needs of Kent County residents suffering from food insecurity or hunger. After identifying these needs, the organization has to assess the reality of each individual situation (what is going on, what needs to be done, data collection, what can be done within community resources, future goals to be accomplished at a later date). See brief outline and overview of critical issues and strategic goals identified by committee. Critical Issues: Participants identified five critical challenges that will impact the ability of ENTF Food Assistance Subcommittee to achieve its purposes. These include: 1. 1. Transportation 2. 2. Long-term causes of food insecurity 3. 3. Health and Illness trends (access to healthy food, education) 4. 4. Increased costs/ Sufficient Resources 5. 5. Demand / Outreach (to new clients, to non-system users, to a diverse population with varying needs / requirements, partnerships) Strategic Goals: Participants identified the following desired outcomes / goals that, if achieved, would address the critical issues 1. Transportation Goals: A. Improve food distribution from the original source to the end user. B. Engage the entire ENTF in addressing transportation issues that affect meeting the community’s emergency needs. 2. Long-Term Causes of Food Insecurity Goals: A. Increase the number of people growing their own food who have been users of food assistance network resources. B. Increase the availability of healthy foods within neighborhoods. C. Increase residents’ participation in programs that foster self-reliance (economic security). 3. Health / Illness Trends Goals: A. Increase residents’ knowledge and ability to obtain food that maintains and improves their self-reliance while reducing the onset and impact of food-related health problems. B. Improve the nutritional quality of food distributed through all sources, including pantries, meal sites, and wholesalers. 4. Increased Costs/ Sufficient Resources Goals: A. Increase institutional (foundations, business, churches, nonprofits, etc.) resources dedicated to the food assistance network. B. Increase community, individual, and recipient support to the food assistance network. 5. Demand / Outreach (to new clients, to non-system users, to a diverse population with varying needs / requirements) Goals: A. Increase participation of eligible residents in community food programs. B. Increase community awareness, support, and partnerships to help meet increasing demand. This report identifies other strategic ideas, which include but are not limited to supporting local farmer’s markets and community gardens, and providing health materials at local events that are nutritional based. Appendix D: What People and Organizations Can Do To Help Organizational Strategies There are many options available to individuals, agencies, and businesses to impact the health of our communities. Below is a listing of ideas and general tips identified by the USDA Summer of Gleaning Project (A Citizen’s Guide to Food Recovery, 2004). 1. Businesses A. Encourage, recognize, and reward employees and other individuals for volunteer service to the community. Increase employee awareness of local hunger and provide training to make employees more useful volunteers. B. Sponsor radio and television airtime for community organizations that address hunger. C. Donate excess prepared and processed food from employee cafeteria or special events to local food recovery programs. D. Donate transportation, maintenance work, or computer service. E. Prepare legal information on donor considerations such as “Good Samaritan” laws and food safety. 2. Food Service Professionals A. Organize a food drive and donate food to a local food bank or pantry. B. Donate excess prepared food from restaurants or catered events. C. Assist organizations in training their volunteers in safe food handling practices. 3. Nonprofit organizations A. Work independently or with existing organizations to assist ongoing food recovery efforts B. Support or develop a community or regional coalition against hunger C. Develop a community financial fund to fight hunger D. Plan tours of food recovery facilities or arrange knowledgeable speakers to increase community awareness of hunger and poverty problems, and what people are doing to address them. 4. Youth Service Groups and Volunteer Organizations A. Work separately or with existing organizations to assist ongoing food recovery efforts. B. Organize essay, oratorical or art contests for school children to focus on a child’s view of hunger C. Sponsor a community garden that gives a portion of the harvest to food banks, soup kitchens, and other food recovery programs. D. Supply gardening tools and harvesting equipment for local gardening and gleaning efforts. 5. Individual citizens A. Volunteer at the food recovery program closest to you. B. Attend food safety training sessions so you are better prepared to volunteer in a soup kitchen or a shelter. C. Suggest that organizations you belong to or businesses you work for sponsor food recovery. D. Join or form a community walk/run to benefit a food recovery program. 6. Specific issues related to Food Recovery projects: General Donor Identification Issues A. The person who is soliciting donations should be familiar with the appropriate Laws-Good Samaritan and Emerson Food Donation Act (A Citizen’s Guide to Food Recovery, Appendix C, www.usda.gov/news/pubs/gleaning/appc.htm) which establish minimum standard Federal policies regarding liability and immunity in every State, and the particular State statutes that may provide additional protection for donors and gleaners involved in food recovery programs. B. Seek appropriate assistance from State and county USDA Farm Service Agency (FSA) offices, which can be found in most phone books under Federal Gov-Agricultural Department. The State Department of Agriculture can also help to identify donors. C. Establish a firm partnership with a local food bank or distributing agency that already has a regular clientele or recipients. D. Solicit Individuals or families for gleaning projects. 7. What can be done to improve food redistribution programs? A. Improve dialog between groups, individuals, and local communities B. Analyze any relevant transportation issues -especially problems with mass transit system C. Develop effective means to educate food recipients on adequate nutrition, especially through self-empowerment, ex community garden or teaching them how to grow their own food, nutritional brochures or workshops D. Expand and explore options for advancement within communities, special volunteer programs with churches, nonprofits, and school E. Create educational materials for existing nonprofit groups who are interested in, but may not have the necessary resources to create similar gleaning programs F. Work towards improving accessibility for the very young and the very old-special delivery programs. This report notes that some additional ideas might be developing food lunch programs in the summer within the neighborhoods, or delivery to seniors, etc. Contact your local Senior Meals on Wheels Program or senior center, local neighborhood associations, or local volunteer delivery programs for more information on what is available in your neighborhoods.
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