Dr. Jack Geiger, founding father of the community health center movement, famously said “The last time we looked in the book for a specific therapy for malnutrition, it was food.” That’s what was behind the farm co-op Drs. Jack Geiger and John Hatch started in the Mississippi Delta more than 50 years ago, and the food prescriptions Dr. Geiger wrote at the Delta Health Center. Like the founders of the health center movement – who recognized that good, nutritious food was essential to good health, and the lack of it, a root cause of many illnesses – so too are health center organizations today working to ensure that fresh, wholesome food is available to their communities. Two current RCHN CHF grantees, supported through our population health initiative, are doing just that.
Mariposa Community Health Center in Nogales, Arizona, serves a predominantly low-income, Mexican- American community situated on the U.S. /Mexico border. Here, food insecurity is prevalent. Limited transportation options, high food costs, and a lack of awareness of diet and nutrition hamper healthful eating. Nearly 14% of the health center’s patients suffer from diabetes, and many have other chronic health conditions. The health center had tried different interventions in the past, but found these weren’t enough to tackle the far-reaching effects of poor diet. Earlier this year, Mariposa launched the “Comer Bien” (Eat Well) Initiative to increase access to nutritious food, address food-related social determinants of health and improve health outcomes. In conjunction with local markets and grocers, the health center is offering cooking classes, transportation to farmer’s markets, and prescriptions for fruits and vegetables through the FVRx Fruit and Vegetables Prescription Program. Focusing initially on improving outcomes for those at highest risk for uncontrolled diabetes, this initiative – which includes community health worker (CHW) visits, care coordination, and tailored, family-oriented programming – is intended to bridge the food insecurity gap faced by many community residents so that they can eat better, and stay healthier.
Idaho Primary Care Association is spearheading a similar initiative. Deeply entrenched poverty, food insecurity and limited transportation options are the reality for many communities in Idaho. The 1st and 16th street neighborhoods of Nampa are no exception, and the impact is reflected in poor health; at the Terry Reilly Health Services (TRHS) sites serving these communities, the proportion of patients with poorly-controlled diabetes far exceeds the statewide average. The evidence-based FVRx is being launched on a pilot basis at two TRHS sites to help combat the problem. The health center is working with the PCA and partnering with healthcare providers, local food suppliers and farmer’s markets and community organizations; like Mariposa, it will initially target for participation people with uncontrolled diabetes and other co-morbidities, those at risk, and their family members. The program includes free transportation to grocery stores, CHW home visits, and access to a dietician to improve knowledge about the importance of diet to maintaining good health. The center hopes to encourage providers to write fruit and vegetables prescriptions, while addressing the health problems that result from food insecurity and empowering patients to adopt healthier eating patterns. If successful, Idaho PCA plans to work with other community health centers to expand the program across the state.
These two program, and others like them, take direct aim at social determinants to improve the health of their communities. Stay tuned for more on the innovative strategies of our population health grantees!
Webinar Recap: Community Health Centers and Family Planning
A special webinar hosted by RCHN CHF, Community Health Centers and Family Planning in An Era of Policy Uncertainty, offered a deep look at the provision of reproductive health care services by community health centers. The presenters, co-authors of March 2018 study released by the Kaiser Family Foundation (KFF) based on a national survey of health centers, addressed their findings on the availability of family planning services at community health centers and discussed implications for policy, financing, and improving quality and access to care. While one in four low-income women get their contraceptives from a clinic-based provider, barriers to accessing care remain; more than 3 million women live in areas without “reasonable access” to a clinic providing a full range of services. Onsite provision of the most effective, long-acting methods of contraception at health centers increased between 2011 and 2017. Still, health centers with Title X funding were more likely to provide a broad range of contraceptive methods and offer services associated with high-quality care. The 2018 funding opportunity announcement for Title X grants evidences a shift in program priorities, and encourages the provision of family planning services in comprehensive primary care settings. However, few health centers report that they have the capacity to absorb a significant increase in new patients: less than one in five reported that they could increase their patient caseload by 25 percent or more in the next year. The speakers discussed this changing landscape for family planning nationwide, and the need to prepare for potentially far-reaching policy changes. Speakers included study co-authors Alina Salganicoff, Ph.D., Vice President and Director, Women’s Health Policy, KFF along with Susan F. Wood, Ph.D., Professor of Health Policy & Management and Sara Rosenbaum, J.D., Harold and Jane Hirsh Professor of Health Law and Policy, both of Milken Institute School of Public Health at The George Washington University. They were joined by Warria Esmond, M.D., Chief Medical Officer, Settlement Health (New York, N.Y.) who provided observations and perspective from the vantage point of a practicing physician and experienced clinician leader.
Didn’t have a chance to tune in? A full recording and the presentation slides can be accessed here.
Chronicles #Membership Monday Spotlight: Morris Heights Health Center (Bronx, NY)
Thirty-seven years since its founding, Morris Height Health Center – known as “The Caring Place” – remains true to its mission of being “the vanguard for quality, affordable and accessible health care for all.”
Finally, here’s a great, inspiring read about Dr. Ethan Gable, the newly-appointed Chief Medical Officer at Jericho Road (Buffalo, NY) in Full Circle: Once a Peds Patient, Now a Doctor at Jericho Road.