How Is Structural Racism Reinforced Through Food?
We sit down with a Jefferson professor to discuss her research on the ways marginalized communities resist oppression, and the impact COVID-19 has had on racial inequities.
Staff, students and volunteers connect with the community through a new initiative.
Jefferson staff and students continue to seek ways to improve lives beyond just providing excellent health care. This spring, through a partnership with the Common Market, a nonprofit that connects communities with food from sustainable family farms, Jefferson began delivering fresh produce boxes to discharged patients diagnosed with and quarantined for COVID-19.
“Food insecurity is a big deal,” says Rickie Brawer, Jefferson’s chief community engagement officer, who notes that food insecurity rates in Philadelphia will likely increase to more than 21 percent in 2020 because of the effects of COVID-19. “People may not have access to healthy, affordable food or may need to make difficult choices between eating healthy, paying rent or getting their medications.”
She and fellow staff member Laura Gontz, director of care coordination, had the opportunity to bring the food delivery program to COVID-19 patients after learning about it through their involvement in a City of Philadelphia task force. They, in turn, reached out to colleagues Nancy Larson and Paula Ostroff in order to help as many patients as possible. Ostroff, Larson and their staff are all on the front lines of talking with patients and asking questions that screen for food insecurity.
“I think it’s great that Jefferson is getting more involved—especially making sure our patients who need food get it and aren’t putting themselves and others at risk by standing in the food lines like everybody else,” Brawer adds.
Help with food, in fact, is the most-used community resource in Philadelphia, according to Aunt Bertha, an online social care network used by Jefferson and other institutions in the city and throughout the country. The network connects underserved populations with food assistance programs and many other free and low-cost resources.
And it’s help with nutritious food that’s vital since it’s not always readily available.
To illustrate this need, Larson, who’s also the director for case management at Jefferson, notes that when her team asked a recently discharged COVID-19 patient what kind of food she had to eat at home, she responded, “Hot dogs, beer and chips.”
Since the start of the food delivery program in collaboration with the Common Market, Jefferson has expanded the food box distribution to non-COVID discharged patients who have been identified as food insecure. After the first two weeks of deliveries, Jefferson saw an uptick of 60 patients a week qualifying for the deliveries. Since that time, 70 patients are benefitting from weekly distributions. To date, that’s more than 400 boxes of fresh produce on the tables of hungry neighbors.
A ‘Foot in the Door’ to Offer Help
Combining forces, hospital case managers and Jefferson’s Clinical Experience Program at Sidney Kimmel Medical College (SKMC) use food insecurity screening questions with patients to learn about their needs before they are discharged. And, in the case of the Clinical Experience Program, community health workers and students follow up with patients who were previously discharged and had indicated in a social determinant screening to be positive for food insecurities and other social needs.
“Case management staff discuss food insecurity while people are still inpatients and this has become part of a health discharge plan,” Larson says. It’s any hospital discharge plan, though, that can offer a devastating pitfall for many patients—and the food delivery program Jefferson is offering is one way to help patients follow their care plans.
Barbara Smith receives a box of produce from Jefferson volunteers.
“It is common practice to instruct a discharged patient to follow up with a PCP (primary care physician), but not everyone has one,” says Ostroff, director of the SKMC Clinical Experience Program. “The community health workers conduct outreach with this target population, so not only are they connecting patients to food, they are connecting them to a Jefferson PCP.”
Because the food delivery program is a collaborative with hospital staff, students and volunteers, it has led to more follow-up with patients. So the program has become an effective way for Jefferson caregivers to build a relationship with patients and ensure their medical needs are being met.
“Getting that first foot in the door to help somebody is probably the hardest step,” Larson says. “People tend to be a little resistant sometimes or they have pride—they don’t want to admit they need help. So if you can make that initial connection and they learn to trust you, I think that just has so many possibilities then.”
Ostroff gave an example of a patient who falls into this category. As a volunteer driver for the program, in addition to being a case manager, she has been able to help build and see the trust developing firsthand.
Jefferson volunteers deliver a produce box to Katherine Butler.
“The patient left the hospital COVID-19 positive. I delivered food yesterday. We’re calling them today to follow up and connect them. It’s our way of saying, ‘We’re health care that really cares about you.’”
Real-World Insights for Medical Students
The program also helps show medical students the realities of what patients deal with.
“When students enter the community, that gives the picture of how to ask questions of the patients,” says Ostroff, noting how the experience of delivering the food boxes can help students improve bedside manner. “They might think about different questions to ask, like ‘How is your home set up?’ If we don’t understand how a person lives, those are the barriers to getting them the help they need. That lens into the patient’s home might trigger different questions to ask when they grow through their careers.”
We got to see their neighborhoods and physical environments and their communities. It gave a unique perspective on patients we wouldn’t normally see. –Student Amber Zhang
“In medical school, we talk about social determinants of health a lot and how there’s more that goes into a patient’s health than just how you see them in the hospital,” says SKMC student Amber Zhang.
She delivered food boxes as part of a project for the community engagement course at Jefferson, a department of family and community medicine elective offered in connection with the Jefferson Center for Urban Health.
“Addressing food insecurity is one of those aspects,” Zhang adds. “Through the food delivery project, we also got to see their neighborhoods and physical environments and their communities. It gave a unique perspective on patients we wouldn’t normally see.”
“Many times people say they’re in a ‘med school bubble,’” says fellow SKMC student and project participant Jeffrey Mu. “This is a great way to get out of the bubble.”
Helping Ensure Patients Eat the Healthy Food
Just providing the food isn’t a guarantee that those who receive it will use it. It’s one thing to give patients the basics. It’s another to help them understand how to prepare them so that they’re delicious.
Enter: recipes. They’re included in every food box, and they were the brainchild of SKMC student and food delivery program volunteer Julia Gong. She developed them for the Maternal Addiction Treatment Education and Research (MATER) patients to whom she’s been delivering food.
Students could help patients navigate through the food process and help them become more food secure long term. –Rickie Brawer
“The recipes are a great idea because a lot of people haven’t necessarily had access to the various types of food provided, so they don’t know how to prepare it so it’s tasty,” Larson says.
“That’s actually the No. 1 thing I hear in the community—‘I don’t know what to do with this vegetable or how to cook it, especially to make it taste good,’” Brawer adds.
Future Plans
With funding for the food box program extended through August, Brawer says that Jefferson is also looking at how to sustain this effort over time.
“Depending on how this model gets built, there may be many opportunities for more students to get involved with home deliveries,” Brawer says. “Students could help patients navigate through the food process and help them become more food secure long term.”
In the meantime, Brawer, Gontz, Larson and Ostroff continue to be vigilant in seeking out food needs in patients.
“We’re looking to increase screenings for food security and add those as standard questions to our hospital admissions electronic health record,” Brawer says. “We hope this will be a long-term strategy.”
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