No More Band Aids – Strategies and Five Tactics for helping your clients long-term by evolving into a health-outcomes based organization
Big Data is Coming for YOU
One day not too long from today, funding for organizations like ours will be heavily based on the social impact returns we can bring against the financial investment made. We will have to make our cost benefit pitch over what improvements in health can we bring. Who are the specific groups we will touch and what specific disease areas will we help to mitigate or eradicate? How much money can we save the City, County, State and Nation in healthcare costs? Over what period can we do it?
If we can put forward a persuasive argument, we will receive funding with the remit to deliver on our proposals. Our food and education programs and our demonstrated ability to link to a continuum of community support and empowerment for under-resourced individuals and families will help us make a strong case.
We will then have to evaluate and measure impacts and wrangle and present the kind of data that makes our current activities in this area seem equivalent to counting on our fingers.
It could be like Feeding America’s quadriannual Hunger Study – every day!
Before you wake up screaming in sweat-soaked sheets, we are not there yet. This may be a world that you don’t want to get to. However, it is coming, whether you like it or not and we need to position ourselves by our deeds to demonstrate the hugely beneficial public health impacts of food banks.
Sure, I am a nice guy who wants to help people be healthy and feel positive about what they can achieve in life for themselves, their families and their communities. But I also care about the long-term direction and viability of organizations and a network like ours. We need financial resources to do our work, and our march into the future is going to require mastery of juggling dual funding streams (charitable donations for food insecurity and provider service fee payments for health outcomes) to be able to survive over the coming decades.
From my cheap seat in the bleachers, hunger is no longer driving the national discussion in the way it did a few years ago. It is already viewed as a sub-component of poverty, which has morphed into the ‘real issue.’ The perception is now that the country has drifted in a situation where people find it incredibly difficult to improve their circumstances no matter how hard they work, no matter how much they take personal responsibility for their own situation.
Partnership with other organizations nationwide and locally is the only way to begin to take on both situational and generational poverty. Feeding America’s fledgling Collaborating for Clients (C4C) initiative is a great step in this direction. Here is a download for some FAQ’s about this: Collaborating for Clients FAQ_1.27.2014
The vital next step after that is ‘collaborating with clients’ to achieve the kind of sustainable transformations in local communities that will work long-term. The Federal government is not going to gallop in on an ethnically balanced white/brown/black horse and save the day. Those days are done. We have to help micro-communities connect and find their own solutions, and then turn around and use their own power and ability to work together to drive the national agenda from the bottom. I mean, what is the point of all this social networking crap unless we can get it to do something worthwhile, right?
Anyway, it’s clearly time for one of my pink happy pills to calm down, because all that is still a ways off and we want to help people be more nutritionally healthy right now.
And so, there is ‘preventative health’ which can be the second flank of a ‘pincer movement’ that enables us to come at the ingrained and complex problems of poverty from two different sides, utilizing different partners. Fighting poverty through job creation and community development is actually not enough in itself. If you improve people’s financial situation, you can make them food secure, but this doesn’t necessarily improve their health. However, if you work to help people improve their health, you give them skills (food literacy) that will be invaluable to them in times of scarcity or times of plenty.
I also think it is possible to steer the issue of poverty away from being a lightning rod for people’s knee-jerk political reactions and deep seated personal fears (oops, same thing) and into a more neutral territory where we treat the ravages of poverty as a public health issue that there can be broad consensus to rally around. That is a ways off, but I think it gives us somewhere to head for that is worth reaching for.
So that is the ‘why.’ What about the how? How can we engage with the current preventative healthcare framework and demonstrate our worth to be part of this fabric.
Below I lay out five different steps you can take. You can’t do all of these things at once (don’t tell my staff that, though), but achieving a win in any of these areas will give you some credibility and provide the foundation to broaden and deepen your health-related activities.
1. Diabetes is a great place to start:
Playing a part in diabetes care is one of the best initial possibilities for demonstrating the vital role we can play in community health. Obesity is much harder for us to prove the specific benefits of our role. (Even for us our food bank with 60% of our distributed product as fresh produce). Diabetes is much easier for us to demonstrate the success of our interventions.
For the last two years, the drug company Bristol-Myers Squibb has been funding pilot programs in diabetes care with three food banks across the country, each pursuing slightly different versions of partnership with local healthcare providers. (Here is some basic information on the project. More detailed data will be released soon.)BMS Diabetes Project 2014 The interim results of these studies provide us with some real data about food banks can play a vital role in screening, helping people control their condition, and also dealing with the huge swathe of ‘borderline diabetics.’ Here is a link to an informational website on this area, which has a lot of helpful info.
We are actively speaking to a number of local health providers in our county about running similar programs. Virtually all of them have been enthusiastic about this. It is a big problem, they can save a lot of money, and they also have funds available for this type of activity. We are still working through how the financial model will work, but we are increasingly looking for fee payments (by healthcare provider, not individuals) for the type of direct service that we are providing in the healthcare space. We can’t be apologetic about asking these organizations to pony up. Yes, people expect charitable hunger relief for $25 bucks and a turkey too big for someone’s oven, but I can assure you that they do not expect to get bona fide health interventions so cheaply.
2. Consider providing training in screening for food insecurity for medical staff:
Oregon and its food bank are way ahead on this one. (what was that Ron Burgundy was saying in Anchorman II about only leaving the country once – when he went to Salem, Oregon?). They have a dedicated site with excellent online and written training materials for medical staff centered around utilizing the existing USDA two question survey to gauge food insecurity.
Of course, medical staff will have a full-blown panic attack if you attempt to suggest adding anything more to the huge clipboard of paperwork needed to be filled in on patient intake (waivers to waive the right to waive waivers and the like). However, persuasive arguments can be made – continuing education points are available in the Oregon model, for which there are existing requirements for medical staff to obtain. Also, being aware that a patient is in a food insecure household is a pretty useful thing to know when you are looking at strategies to improve the health of that patient.
The other major potential sweetener is the possibility of providing doctors with the ability to ‘write prescriptions’ for fresh produce for some patients. They could then bring these prescriptions to a food pantry (ideally one that would be open at that time) where they could receive some fresh produce. Medical staff like to have something to give patients, and even if they have to pay something to help contribute to the cost of fresh produce, it is still a small cost compared to other interventions they could offer.
3. Get in on the ‘Community Health Needs Assessments’ wagon train:
This was supposed to be our admittance ticket, our way of building relationships with local hospitals and health authorities. They are now mandated to see what is happening with the health of their communities and devise strategies to deal with these issues. Food insecurity is a significant portion of this reality, as well as the health conditions that optimum nutrition can help alleviate.
We actually contributed to our local plan a few months back in terms of being invited to a stakeholder interview roundtable. We are still at the stage where we were not considered partners, more a case of ‘we better ask a bunch of nonprofits what they think.’ Consequently not much significant has resulted from our modest involvement in this process. In your area, you may be able to insert yourself at a more opportune point in the process and be more involved. From our viewpoint, I figure that we need to get on with the other things we are doing in this area, and then when next time rolls around, things will have shifted significantly.
Here is a download on this issue.Assessing and Addressing Community Health Needs_CHA_2013
4. Stop whining that the bigger fish get all the fish food. Puff yourself up bigger to get bigger funding:
I am not talking about increasing the size of your organization, which may not be a good idea even if it is financially possible. What I mean is to link together with other food banks or similar organizations to run health based programs over a broader geographical area. While I may have my visionary moments, most of the strategies I pursue have a very pragmatic basis. Such is the case with this. Trying to get the Feds to cough up for the dire needs of those in hunger in Santa Barbara County is an uphill struggle. Why, dear reader, even you are smirking now. What do they know about hunger? We always have to deal with the kneejerk reaction of having one rich city in a county with rampant food insecurity and low food stamp uptake. (In the 58 California counties, only 14 have more food insecurity than Santa Barbara). Also, the reality is that if you are looking for health money not USDA food security money, a county of 400,000 is a gnat bite. They want big populaces to make significant impacts on regional numbers.
This is one of the reasons for the formation of the ‘Food Bank Health Alliance of the Central Coast.’ This is an aggregation (currently) of ourselves, Santa Cruz and Ventura Counties. Between us, we have a million and a half people. If we can get San Luis Obispo and Monterey County to join us we will have an unbroken line of sister organizations covering the whole coastal region that separates LA from San Francisco.
Our organizations are linked by MOU committing us to jointly seek for health related federal funding (though we’ll take money from USDA, Department of Defense, Smokey the Bear…). Marriages of convenience without shared values and objectives are a recipe for disaster – as I’m sure you’re all aware from your previous collaborations – however, this more open relationship is based on a shared outlook. This boils down to:
- GOOD NUTRITION – Is the bedrock of our activities, sourcing and distributing as much nutrient dense food as possible. We also have nutrition and wellness policies so we can walk the talk (and help our member agencies do so).
- COMMUNITY EMPOWERMENT AND DEVELOPMENT – As well as making a success of ‘feeding the line’ of people who are food insecure, we are also very focused on ‘shortening the line’ of those who will need help in the future. The only way to achieve this is through empowering the community to take control of its own nutritional challenges – on an individual and neighborhood level and upwards. This involves making those who were previously ‘clients’ into partners for healthy lifestyles and environments.
- EVALUATION OF IMPACT – A need to move beyond measurement of outputs to demonstrating the efficacy of our actions on the public health and development of communities. We will additionally work to demonstrate wellness and self-sufficiency.
- A HISTORY OF COOPERATION AND MUTUAL TRUST – We have a long shared history as members or partner distribution members of Feeding America, the national organization of Food Banks as well as the California Association of Food Banks.
There will doubtless be lots of challenges, different organizations used to running their own unique programs in their own idiosyncratic way. However, unless we can make this type of collaboration of very similar organizations work, then none of us have any hope at succeeding in collaborating with the wider groupings that will be necessary to have a true impact on poverty in America.
An ‘alliance’ like this needs large amounts of cash to grease the wheels and make it work, so stay tuned for results on how we’re doing. Or better yet, why wait to see whether we fall flat on our faces and put together your own regional collaborations. If the Feds don’t give you the money, they’ll only spend it on something really dumb, so you might as well go for it!
5. Lead with Seniors:
Often, funding to feed seniors is treated in a similar way to finding the money to feed homeless people. Besides a few highly motivated donors, these are the programs that it is harder to get broad funding for, so they tend to get paid for out of general operating expenses. It’s a shame, but scruffy dudes with matted beards or finicky grey hairs clipping coupons do not always excite funders. Consequently, it’s so easy to lead with kids and get funding for those kids. (I call it ‘taking candy with a baby’) Individual donors or foundations feel the heartstrings twang and they also think kids might be a better long-term investment. I have always muttered that ‘Kids are just the Seniors of tomorrow,’ but that hasn’t made much difference. I have been waiting for some perspective to shift or something to click for me in this area and I think it just did.
At a recent meeting with a major healthcare provider, he said: “Kids are basically healthy unless you really mess them up, but seniors are a significant expense.” If you think about it, asking the health world to pay up now to ease the problems kids will generate thirty years from now is asking too much. If we can help them keep seniors healthy and independent as long as possible, we can save them some serious cash in the here and now, not after they’ve retired or moved on. That is something that they would be prepared to invest in – and the sums would be a drop in the ocean compared to the increased expenses they face.
In this case I am thinking about a more integrated and expansive range of senior nutrition programs that move beyond the straightforward grocery bags or congregate feeding. These programs would have a nutrition and health element and that mesh more organically with existing health screening.
We are still putting together the right mix of ideas and partners before making a significant investment, but it has to happen and soon. We are seeing an explosion of need amongst seniors and what might be termed ‘pre-seniors’ (those close enough to retirement age that they are finding it very hard to get employed as people don’t want to invest training cash in them). Really, once you are in mid to late 50’s it gets harder and harder (So that’s why those Food Bank ED’s stay so long in their jobs!) To give an example of the type of programs we are looking at in the senior arena:
• A program providing ingredients for seniors to cook a meal together a couple of times a month at a community or senior center. This would give people motivation to keep their cooking skills going and also allows social contact, additional nutritional education and health screening from other healthcare groups.
• In seeking to meet the needs of our large Latino community, we are looking at a program that caters to the large number of grandparents who look after kids while their parents work. This program would also allow for a weekly meal in a community center where both generations would work together to cook a meal. This way, nutritional health and food literacy skills can be the focus for these two age groups, who if they disagree about a lot of things, are united in their belief that mom and dad can’t cook to save their lives, or that they are convinced they don’t have the time to. Again, this situation offers great health screening opportunities for diabetes etc.
• Meal delivery to seniors. In our area (and maybe yours) senior meal delivery has become a hot potato (or a reheated lukewarm potato, more like) with responsibility for the service being passed around. Meals on Wheels may be a large presence in your area or one that is suffering from a volunteer force that is figuratively and literally dying off. The reality in many places is either some kind of vacuum or spotty service at best. We are interested in investigating partnerships in this area. At one extreme, you can be like Feedmore in Virginia and create one big entity of MOW, food bank and community kitchen. At the other is at least more collaboration and integration within the range of services in your area. I know that Greater Chicago Food Depository has been piloting a program where health visitors drop off an ergonomic box of six frozen meals with low-income seniors that they visit. These are to be picked up from various centralized locations, and the frozen element allows delivery before food safety becomes a major issue. For the health visitors it is obviously an inconvenience but also provides something tangible that they can give people and that helps them make their numbers and keep their clients happy. This is a complex strategy and I know that there have been significant challenges with it, though this is clearly a direction worth pursuing and seeking the type of local and state reimbursement funding which would make it more financially viable.
It is up to you how tightly you are able to integrate this type of programming with the health screening and health treatment needs of seniors, but the tighter you do so, the more you guarantee a stream of funding. Food is still the draw to get involved in a program whether you are seven or seventy.
Feeding America recently published a report on Senior Hunger, which may provide some help to you in pushing for funding and partnership in this increasingly vital area of our operation.
Link to executive summary of this report: Spotlight on Senior Health
Are the tactics I have suggested a distraction from your core mission of feeding people? I would argue that they enhance the mission in multiple ways. Take the suggestion around training medical staff to screen for food insecurity. Can you imagine how much your development staff will benefit from the type of new understanding that doctors and health teams will gain of both food insecurity and our work to eradicate it? People want to get involved when the discussion is good nutritional health, and now is the time to start leveraging our credibility and boots on the ground in this area.
Also think about attending the ‘Closing the Hunger Gap’ conference, which has become a key focal point for this and related issues. Closing the Hunger Gap Conference Report 2013 which held its inaugural conference last year in Tucson and will next be held out of the country in Oregon in September 2015.
Live Long and Prosper, and let us know how you’re doing!