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Food insecurity: Growing Wellness on Wheels
How health systems can address food insecurity
The numbers are devastating: In 2019, 10 million kids in the US — more than 52,800 on Long Island — experienced food insecurity. Millions more kids and families don’t have access to quality food: They live in areas considered food deserts, meaning they lack access to affordable nutritious groceries. As health care professionals, we know that healthy bodies and minds require nutritious meals at every age. We also know that health care systems like Northwell can make a difference.
What is food insecurity?
Food insecurity is defined as lacking consistent access to adequate food needed to live an active and healthy life, according to the US Department of Agriculture (USDA). There is a range of reasons why approximately 40 million Americans struggle with food insecurity, which the USDA breaks into two categories:
- Low food security: A household may have enough food, but the low quality or lack of variety may deprive them of good nutrition.
- Very low food security: This group may miss meals and lack the resources to acquire enough food to meet their needs.
Those who live in food-insecure households face many overlapping challenges, such as living in a food desert. Social determinants of health often impact minority communities hardest, and can include:
- affordability issues
- unemployment
- lack of nutritional awareness
- transportation/mobility problems
If people are facing housing issues, they may lack the amenities they need to cook healthy meals, and that could lead to an overdependence on processed or fast foods high in calories, fat and sodium. This has a direct impact on the prevalence of obesity, diabetes, cardiovascular disease and disability. Among adolescents and teens in the US, obesity and pre-diabetes have reached critical levels, jumping to nearly 40% and 30% respectively, according to a recent JAMA Pediatrics analysis. Among children living in poverty, the prevalence has more than doubled since 1999.
The Covid-19 pandemic has only worsened food insecurity and other social determinants of health. At Northwell, we conduct regular community needs assessments to better understand how those issues are impacting the areas and people whom we serve every day.
Listening to our communities, we continue to build and adapt programs to help based on their expressed needs. Increasingly, we hear that food insecurity, particularly among children, is the No. 1 issue.
Wellness on Wheels
When schools closed due to the pandemic, Northwell had to halt its existing school-based nutrition programs. These are focused on childhood obesity prevention, nutrition education and physical activity. We identified the school districts most in need during Northwell’s last community assessment.
Eager to get back out into the communities, our team reimagined the program, which is a collaboration between Cohen Children’s Medical Center and Northwell's Department of Community and Population Health. Now called Wellness on Wheels and run out of a food truck-style van equipped to deliver nutrition education outside, our clinical and community outreach experts are finding innovative ways to influence children’s behaviors before they progress.
Rather than a class or assembly room, students from Kindergarten through 2nd grade get to go outside for a 20-to-30-minute interactive learning experience — enabling everyone to maintain social distancing, while reaping the benefits of time outdoors. Operating like a pit crew, the team quickly sets up and breaks down activities in between sessions, anchored by the Wellness on Wheels mobile van, which run throughout the school day.
In the fall, children learn about the five healthy food groups that make up MyPlate, the USDA’s current nutrition guide. In the spring, students split their time between three stations:
- At the “Grow” station kids learn how to plant seeds and grow their own vegetables.
- At the “Healthy Hydration” station they learn about the importance of reducing sugar intake from sweetened sodas and hydrating with water instead.
- At the “Be a Fit Kid” station they engage in quick and fun exercises and learn the importance of moving every day.
Gianna Lynn Martinez, 10, never thought she would like asparagus (or, as she pronounced it, “ek-spare-a-gus”). Following a virtual food demonstration from Northwell Health executive chef Sonny Rios III, students received a bundle of asparagus to take home with them to try the recipe for seasonal asparagus salad. To help them put their new nutritional knowledge into practice at home, students in the initial program were also given a recipe book with nutritious and easy-to-prepare foods.
“Me and my mom actually cooked asparagus,” Gianna said, sounding surprised.
And she’s not the only one. Nearly two-thirds of students who have participated in the program said that they tried a new vegetable and 88% correctly labeled three out of the five healthy food groups that make up MyPlate. The cost of food distributed to students is funded by Subaru.
Tackling child food insecurity
Inadequate nutrition can also impact children’s ability to learn, their social interaction and their productivity. These kids can fall behind their food-secure classmates; poor nutrition has also been linked to higher absenteeism, declining performance on reading and math tests, as well as behavioral problems like hyperactivity, aggression and anxiety.
To fully address food insecurity, parents need to buy in as well. The “grow” portion of Wellness on Wheels’ Spring sessions — which covered eight schools in Brentwood in 2022 — targets both child and parent. Students are sent home with the plant they pot at school, as well as a pack of seeds for parents to make use of. The kids also took home a recipe book (in English and Spanish) they can try out with their families.
Through Wellness on Wheels, we’re learning that children can actually influence parents. Despite the barriers to access, cooking a vegetable or growing a seed that a child brings home from school becomes a meaningful family activity. Families may not have a garden to plant seeds, but parents can place a pot on the window sill, which is one step toward healthier habits and making a household more food secure.
Wellness on Wheels visited seven elementary schools during the fall of 2021, educating 1,883 first and second-grade students. The program will expand to third, fourth and fifth graders this fall.
Entering its second year, the Wellness on Wheels team is dedicated to reducing food insecurity throughout the region by increasing access to healthful foods.
Through grants from the Rite Aid Foundation and Mother Cabrini Health Foundation, the Northwell team is expanding its programming to new locations, including area food pantries, and will add services to directly provide healthy food and expand food access. This summer the team plans to bring Wellness on Wheels to food pantries in Hempstead and Springfield Gardens.
In addition to offering education to more members of the community in need, we plan to distribute approximately 2,000 weekly fresh produce boxes and enroll approximately 200 families in Supplemental Nutrition Assistance Program (SNAP) benefits.
Debbie Salas-Lopez, MD, calls on community leaders to partner together to address social determinants and fix health disparities.
Read more
A local response to food insecurity
Wellness on Wheels is one of many programs Northwell has launched to address food insecurity with the goal of health equity across all zip codes. Here are three ways health systems can help address food insecurity in your local community.
Listen to community needs: Food insecurity crosses many demographics. To understand the local community and its specific needs, health systems must engage with community leaders to properly tailor programs and services. Northwell conducts focus groups in all six counties it serves through a community needs assessment. Additional listening tours and outreach efforts are essential to understanding the root causes of food insecurity in a community.
Create a partnership ecosystem: Programs like Wellness on Wheels would not be as effective without the help of community partners. It’s important to support the organizations to which you refer patients. Recognizing that many children lack access to food at home, Northwell supports Island Harvest Food Bank’s Kids Weekend Backpack Feeding Program, which sends students home with backpacks filled with shelf-stable food (canned tuna, pasta, pasta sauce, beans, rice). Intended to fill the gap in access to healthy school meals from Friday to Monday, the program has distributed approximately 15,000 meals and snacks.
Another benefit of health systems working with community groups: By referring patients to foodbanks or local pantries, we’re helping identify people in need.
Apply for grants: A small amount can have a big impact. Thanks to several foundation grants Northwell has purchased a second Wellness on Wheels van. In addition to funding maintenance of the vehicle, it will enable us to offer more programs and services to schools, churches and local pantries.
Anastasia Schepers, MS, RDN, CDN, CLC, nutritionist and clinical program manager, Cohen Children’s Medical Center
Debbie Salas-Lopez, MD, MPH senior vice president, Population and Community Health, Northwell Health
Contributors:
Jodi DeMasco, Community Outreach Specialist, Cohen Children’s Medical Center
Kayla Altoonian, MPH, CHES, Community Outreach Program Manager, Cohen Children's Medical Center
Edward C. Fraser, MHA, vice president of Community Relations and chair of Northwell’s EXPRESSIONS BERG
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