Episode 96: What Happens When a Medical System Makes Food Security a Priority?
February 16, 2022
About the Podcast
Food insecurity has been documented to affect health outcomes. Many diet-related diseases — diabetes, hypertension, heart disease, and obesity — have been associated with this issue. Pediatrician Dr. Rigas shares details on her comprehensive programming that exemplifies how hospital systems can ensure their patients get the food resources they need.
About Mary Ann Rigas
Dr. Mary Ann Rigas graduated from the Perelman School of Medicine at the University of Pennsylvania and completed her pediatric residency at the Children’s Hospitals of Boston and Philadelphia. She has practiced general pediatrics at UPMC Cole in rural north central Pennsylvania for the past 31 years. Dr. Rigas is the vice president of the Pennsylvania Chapter of the American Academy of Pediatrics. She loves the unique challenges and rewards of rural pediatrics and feels very fortunate to be able to pursue her passions of breastfeeding promotion, prevention of childhood obesity, oral health in the pediatric office, and addressing food insecurity.
Discussion Takeaways
- Rigas completed her pediatric residency at the Children’s Hospital of Philadelphia 31 years ago and came to practice general pediatrics in Potter County, a small county in rural north central Pennsylvania. Over the intervening years, she has come to appreciate the unique challenges and rewards of rural pediatrics, including the opportunity to care for multiple generations of children in the same families. Her passions include breastfeeding promotion, prevention of childhood obesity, and oral health in the pediatric office, among others.
- She is a member of our local Community Health Needs Assessment focus group, which several years ago, identified the problem of food insecurity as one of the top three priorities in need of addressing in our community. In several towns in her community, she witnessed the closure of grocery stores and the opening of dollar stores, mirroring a trend that is occurring in rural towns all over the country. As a volunteer at our local food pantry, Dr. Rigas observed that many of the food choices available to customers were high in caloric content and low in nutritional value. She was also struck by the paucity of fresh fruits and vegetables offered at the food pantry.
- As a pediatrician, she provides anticipatory guidance to parents on a daily basis about the importance of healthy nutrition for their children, emphasizing the importance of drinking water instead of sweetened beverages, eating fresh fruits and vegetables, and limiting portions of unhealthy snacks and sweets. Recognizing the incompatibility of her recommendations with the reality of choices her patients faced, led her to the idea of developing partnerships on a local level among various groups such as gardeners, farmers, schools, community organizations, and food pantries to make healthier free and low-cost food choices available to food-insecure families and to explore ways to provide nutrition education and healthy recipes to families.
- She’s applied for a Community Access to Child Health (CATCH) planning grant from the American Academy of Pediatrics and was awarded that in early 2020. Not surprisingly, the COVID-19 pandemic caused her team to adapt some of their activities to assure the health and safety of those involved. What did surprise her and her team was the enthusiasm of everyone who participated in grant activities and everything they were able to accomplish. Some of those activities included:
- Surveying families with children at food pantries and WIC offices about their needs and preferences for procuring and serving healthy foods to their families and barriers that prevent them from doing so
- Developing a coalition of community partners to brainstorm and implement ideas for improving nutritional value of foods provided to food insecure families - partners included representatives from local food pantries, regional food banks, WIC and SNAP programs, local farmers and gardeners, school personnel, Chop Out Childhood Hunger, Penn State Extension, county commissioners, and care coordinators
- Developing a flyer of local food resources in four county area served by UPMC Cole (updated at 6-month intervals)
- Presenting the case for screening for food insecurity by all medical providers at UPMC Cole and providing the food resources flyer for them to give to families when food insecurity is identified. They are screening electronically in the pediatric offices and other offices within the hospital system are now beginning implementation.
- Developing an "alternative healthy foods" list that organizations can use to provide suggestions for food pantry drives
- Soliciting targeted monetary donations at a local church and using it to purchase fresh produce for distribution at our local food pantry. This occurred in conjunction with the local registered dietitian who recorded a video of the recipe to prepare the fresh produce, gave out cooked samples and the ingredients to prepare the recipe, and provided the written recipe with a QR code to the video.
- Holding summer "kids' camps" in which children and parents visited a local Community Supported Agriculture (CSA) farm and then participated in cooking class with our registered dietitian using ingredients harvested at the farm
- Holding another kids' camp in which children and youth volunteered at the local pantry preparing and serving a fun and healthy snack to customers (snacks included yogurt and fruit parfaits, raisins and peanut butter on celery, etc.) - customers' children were invited to participate in preparation and consumption of the healthy snacks
- Connecting local school districts with regional food banks and Child Hunger Outreach Project to develop backpack programs and school food pantries
- Holding virtual meetings with Pennsylvania Agricultural Surplus System (PASS) and Pennsylvania Sustainable Agriculture (PASA) to learn about their programs and how they may benefit farmers and food insecure families in our service area
- Connecting a local food pantry with their regional food bank's Healthy Pantry Initiative
- Finally, they are now partnering with UPMC Cole (a healthcare system) and Potter County Penn State Cooperative Extension to develop a community garden for next spring and summer. They are still in the planning stages but my hope is that at least some of the produce will be donated to and distributed at our local pantries.
- In Dr. Rigas’ pediatric practice, they screen for food insecurity using the two “Hunger Vital Sign” questions. Parents and youth complete the questions electronically on a tablet at the beginning of well child and adolescent visits, at the same time that they are answering questions about development, emotions, behavior, and substance use. When the office identifies food insecurity, they provide a copy of the food resources flyer that they developed and update every 6 months. It lists all the food pantries and soup kitchens in our service area with location, days and times of food distribution, and contact information. The flyer also provides information about how to access WIC and SNAP benefits. Dr. Rigas also engage the family in a conversation about the fact that they may be eligible for more than one local food pantry or soup kitchen depending on their geographic location and explain that while each pantry has specific days and times of operation, it is almost always possible to contact a pantry in a time of emergency and someone will assist them in meeting their needs. She also talk about ways of shopping for healthy food on a budget, including choosing fresh fruits and veggies that are in season; substituting frozen fruits and veggies for fresh; and saving money by not buying sweetened beverages, processed snacks, and sweets and using it for purchases of other nutrient-dense foods instead. Finally, I make sure they know that they can use SNAP and WIC benefits at local farmers’ markets and stands.
- When they launched our food insecurity screening about one year ago, Dr. Rigas gave a brief presentation to the primary care staff about food insecurity screening and provided all the offices with the food resources flyer.
- Some of the other social determinants of health that her office screens for with electronic questionnaires include housing insecurity, maternal postpartum depression, domestic violence, child abuse, substance use, and mental health disorders in parents and children. They have flyers about local resources available for all of these issues.
- For clinicians who want to fight hunger in clinical settings, it is important first to screen for food insecurity. Each clinician will need to figure out how he, she, or they feels comfortable performing this sensitive screening – electronically, on paper, or verbally. Then, of course, it is important to be aware of available local resources to refer food insecure families to, including pantries, soup kitchens, farmers’ markets and stands, and local WIC and SNAP offices and to determine the best way to communicate the information to families, again in a sensitive way.
#1 tip to improve access to healthy food
For those who feel passionate about helping families with food insecurity, you can look for ways to create new food distribution programs, either in the clinical setting or in the community. If you are like Dr. Rigas, you will be amazed at the ideas people have and their willingness to help out!
Each week on the Food Dignity® Podcast, the Food Dignity® Movement's Clancy Harrison hosts a wide variety of hunger experts and other people making changes on the frontlines. Join us as we dive deep into conversations that will change the way you think about food insecurity.
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