Yale Daily News Reports on Fresh Advantage’s Work with Connecticut Mental Health Center

The Yale Daily News, the nation’s oldest college daily newsletter recently featured an article on Fresh Advantage and their work with Connecticut Mental Health Center (CMHC). “Food for Thought” discusses the work of Marydale Debor, Chef Ann Gallagher, and Francine Blinten with the vulnerable populations served by CMHC.


“First question — who’s hungry?”

This is Anne Gallagher’s opening line as she addresses the small group huddled before her around a kitchen table. Clad in a white chef’s coat embroidered with her name, Chef Anne — as she is called by everyone — is a professionally trained chef who owns a successful farm-to-table catering company.

But today, she won’t be making hors d’oeuvres. On the surface, she will be teaching the group a simple skill: how to cook a chicken. In reality, though, she has a much bigger goal in mind: teach her small audience how to eat healthy despite struggling with mental illness and living on less than $6 for food per day. For the group of outpatients gathered before her in the fifth floor kitchen of the Connecticut Mental Health Center, food — and health — can never be taken for granted.

The Connecticut Mental Health Center is a community mental health center co-run by the state of Connecticut and Yale with the mission of providing mental health care to low-income and underserved populations. Its five-story building, with enough beds for only 42 inpatients, sits in the shadow of the much larger Yale-New Haven Hospital right across the street. Still, CMHC serves around 6000 outpatients each year, and often up to 2400 outpatients at any given time.

“These patients are the poorest of the poor and sickest of the sick,” says Marydale Debor, who runs a firm called Fresh Advantage that began working with CMHC in 2011 to design and implement a new set of food policies. “We’re looking at an institution that’s serving people that are really deprived.”

A part-time chef, part-time educator, Chef Anne is just one member of a team that runs the “Better Eaters Club” at CMHC. Every Tuesday afternoon, the group of outpatients and peer facilitators — alumni of the program who return to help — meets in CMHC’s small fifth-floor kitchen, well-lit by the large windows lining the wall and lending a view of the hospital across the street. There, they learn how to shop for, cook and eat healthy food on a budget.

Better Eaters Club is just one branch of a larger effort at CMHC to change the way that patients and staff approach food. The changes are everywhere, from the cafeteria to the staff lounge to outpatient programming, all envisioned by Debor and implemented by Bob Cole, chief operating officer of CMHC.

“The Better Eaters Club,” Debor says, “is part of a whole constellation of changes.”

As an institution that serves both inpatients and outpatients, food is present in CMHC through two main channels: the cafeteria, where outpatients and staff eat, and in-room food service for inpatients.

Before this year, food was not prepared on site — it came from the YNHH cafeteria and was transported to CMHC through an underground tunnel. There were also numerous vending machines throughout the clinic that sold sugar-sweetened beverages. As a result, Cole says, patients at CMHC were developing medical issues on top of their psychiatric issues.

For the entirety of the article, visit the Yale Daily News.


Root Cause Coalition Addresses Hunger as a Public Health Issue

October marked the formal announcement of the Root Cause Coalition, a joint venture between ProMedica and the AARP Foundation that aims to become a national leading advocate of programs, policies, and research to eradicate hunger, food insecurity, and health disparities. Led by ProMedica CEO Randy Oostra, the coalition’s overall goal is addressing hunger as a public health issue. A key focus will be building on research that links hunger and food insecurity with both chronic disease and acute medical conditions.

Root Cause Logo

Fresh Advantage is pleased to see large, influential organizations like AARP and ProMedica tackling the serious problems of hunger and healthy food access, which are a core part of our work. Because involvement at the CEO level is crucial to effecting genuine change, we are also encouraged by Mr. Oostra’s leadership as evidence that food justice is penetrating the health care paradigm.

Fresh Advantage consultant Vanessa Lamers, who attended the kickoff of the Root Cause Coalition at the National Press Club in Washington, DC, reports the event began with a strong call to action from Congressman Jim McGovern (D-MA), who drew connections between hunger and obesity. Among the coalition’s early goals are universal patient screening for food insecurity by 2025, research partnerships with the Centers for Disease Control, best practices toolkit development, and a convening of health care leaders and prominent hunger relief organizations for a White House Summit.

To accomplish their wide-ranging goals, coalition members will:

  • Engage in the ongoing development of relevant, effective strategies to significantly reduce food insecurity and its outcomes in the communities they serve and across the nation;
  • Have access to and participate in relevant research studies to identify gaps and best practices that can be implemented in member communities;
  • Participate in education sessions that add context to current research on the social determinants of health and provide proven strategies to improve community health outcomes;
  • Advocate for policy issues that correlate and encourage community benefit, prevention, and health outcomes associated with hunger and other social determinants of health; and
  • Have access to programs and tools that can be easily and effectively adapted to address specific community health and prevention needs in clinic and office settings and during acute and postacute care periods.

Coalition members have opportunities to participate in regular webinars, an annual education and best practices conference, advisory committees (e.g., congressional advocacy, clinical and research issues, and education), and other regularly scheduled events by the Root Cause Coalition and its partners.


Fresh Advantage featured at Yale Master’s Tea


On October 14, Fresh Advantage’s Managing Director Marydale DeBor, partner Chef Anne Gallagher, and Fresh Advantage affiliate nutritionist Francine Blinten enjoyed “Tea” (a longstanding Yale tradition) with the next crop of eager healthy-food champions on campus at Pierson College. This Fresh Advantage trio was delighted to be the first special guests in the Yale Sustainable Food Program’s 2015–16 speaker series “Women of Food.” The afternoon’s theme was “Women Addressing Food in Healthcare.”


Women in Healthcare

From left: Bella Napier, Professor Stephen Davis, Chef Anne Gallagher, Annie Harper, Marydale Debor, Francine Blinten, and Robert Cole.

Francine discussed the progress being made by the Fresh Advantage team in the “food transformation initiative” they now lead at the Connecticut Mental Health Center. Chef Anne (pictured below with several Yale students) prepared a delicious tea with food from the Yale Farm. Dishes included kale bruschetta topped with parmesan, scarlet turnip and squash pancake topped with sour cream and a hot pepper coulis, and roasted beet skewers with pecan-crusted goat cheese drizzled with balsamic reduction.

For those who couldn’t attend the event, an accompanying podcast interview with Marydale is available here. (Please see below the photos for additional information.)


Vegan roasted beets from the Yale Farm

Vegan roasted beets from the Yale Farm

Listening to Marydale’s interview won’t make up for missing the mouth-watering food, but you will hear details of our “hub and spoke” theory of change for hospital food systems. Hospital food service operations can serve as the healthy food “hub” for patient, staff, and visitor meals, and they can support a variety of activities from patient nutrition education, employee wellness, and programs that address food insecurity in the community at large (the “spokes”). In fact, food and nutrition programs that address community health needs, such as food insecurity and malnutrition among seniors, are a creative and effective way for non-profit hospitals to fulfill their community benefit responsibility, a condition of tax-exemption. You’ll also learn which two groups in any hospital are our closest partners in implementing change in hospital food systems. (They may not be your first guess.) Who are they? Marydale specified two groups: plant engineers (“the first people I talk to are the ones who make the building run”) and nurses (“nursing is the other critical piece—nursing is the backbone of the hospital”).

Tune in to learn other features of our Food is Primary Care® approach to ensuring food and nutrition are valued as a central part of health care practice.



THE “GREAT NATIONS EAT” CAMPAIGN: “Slovenia, Let’s Help America.”

This guest blog by Fresh Advantage Director Marydale Debor first appeared on Food Solutions New England. You can view the original blog in full here.


This past July 4th, Share Our Strength, in collaboration with a leading advertising agency, filmmakers, and media outlets, launched a public awareness campaign that deftly challenges assumptions about America’s  “greatness,” perhaps even our sense of national identity and the direction of our moral compass in the face of our nation’s ongoing hunger epidemic.

umass dining D14148B015 small


In a series of PSAs that are a part of the campaign, Slovenian, German, and Chinese adults, speaking in their native languages, are featured together with images of US children in local neighborhoods. US hunger statistics that exceed rates in these other developed countries are recited, with English subtitles, ending with an appeal that their own country come to America’s aid.

Some commentators have characterized the PSAs as a spoof on traditional charity ads, although they are hardly funny. Rather, the ads give a new perspective on this statistic: 48.8 million Americansincluding 16.2 million children—live in households that lack the means to get enough nutritious food on a regular basis.

How can that be?  In the greatest nation on earth?  Something must be very wrong.

Clearly, the root of this domestic evil is not lack of capacity. The fact that millions of Americans suffer from “limited or uncertain availability of nutritionally adequate and safe foods [accessible] in socially acceptable ways” stems from the lack of political will needed to address the complex problem of hunger, married as it is to pervasive poverty, expanding inequality, and the poor health status of Americans in comparison to the citizens of other developed nations.

So, the question becomes where to turn—within—for answers. What can America do? Advocacy and action by community “anchor” institutions can help:

  • Schools must stay the course with respect to following the nutritional guidelines set by the USDA. School districts could extend their programs, for example, to supper service and summer meals.
  • Non-profit hospitals can focus their community benefit programs on supporting local programs that provide access to nutritious foods through partnerships that
    • Provide support to USDA school and early childhood feeding programs
    • Enable food banks to increase their inventory of nutritious and fresh foods
    • Offer double-value coupon programs to extend SNAP benefits for the purchase of fruits and vegetables at local farmers markets
    • Invest in upstream, “community building” food system development, such as food hubs. For suggestions, see this discussion on how non-profit hospitals can partner with local and regional food systems to increase access to nutritious food.
  • Hospitals can join forces with USDA feeding programs, as Arkansas Children’s Hospital and Hennepin County Hospital (Minnesota) have done by becoming sponsor sites for summer meals programs.
  • Food banks can take advantage of Affordable Care Act–based changes in health care by becoming more active in promoting community health efforts, such as adding food assistance on site at health care institutions. For suggestions, see Food Banks as Partners in Health Promotion, a report published by Feeding America and The Center for Health Law and Policy Innovation at Harvard Law School.

Finally, individual voters can insist candidates running for political office (federal, state, and local) articulate their “food policy.” A credible food policy should not be limited to supporting essential public nutrition programs such as SNAP and school and summer meals for low-income children. Instead, such a policy should include measures and funding to improve access to adequate nutrition linked to agricultural and economic development. We need regional and national food policies that will encourage the development of small and mid-size farms and new growing methods. Diversified production can create jobs and economic independence as well as increase the supply of healthy food.

By electing representatives who will pursue policies aligned with the “American values” of independence, strength, and productivity—even the humanistic and patriotic desire to take care of our own—we may not need help from Slovenia . . . or China . . .  or Germany.


Back to Basics and Beyond Charity Care

This post first appeared as a guest blog for Food Solutions New England (FSNE). You can view it and their website here


On May 8, 2015, the Connecticut Food Policy Council convened a state-wide Summit to explore how a new federal regulatory development applicable to tax-exempt hospitals opens opportunities for hospital-community collaboration to strengthen food and nutrition programs and food systems that can prevent hunger and food insecurity.

Hartford Mobile Market

More than 100 representatives of Connecticut tax-exempt hospitals, public health and social assistance agencies, local farmers markets, urban farmers, and other food system stakeholders gathered at Middlesex Community College to learn more about the final IRS Rule (December, 31, 2014) implementing the Affordable Care Act (2010) provisions mandating that, in order to maintain tax-exempt status, hospitals must comply with a multi-step regulatory framework, every three years, to:

  • Assess community health needs using reliable data, with input from public health agencies and community stakeholders,
  • Assign priorities to the needs identified, and
  • Create and execute an “Implementation Plan” that includes evaluation methods and metrics to addressing the priority needs.

The process is intended to foster continuous quality improvement and requires annual reporting of actual activities and impact, so that every future community health needs assessment and implementation plan builds upon the lessons learned and achievements of the prior cycle.

The final rule makes clear that “significant health needs” are not confined to clinical health careservices that hospitals might provide as charity care, but includes social determinants of illness, such as “access to adequate nutrition” that are essential to the health of people living in the community served by the hospital.

Summit presentations included:

  • Highlights of the the new legal provisions, especially the inclusion of “access to adequate nutrition” as a significant health need at the community level that can be addressed in the community benefit activities of tax-exempt hospitals. Inclusion of this language by the IRS in its Final Rule came about as a result of the many public comments received from community organizations across the country that witness the effects of hunger and food insecurity in communities every day.
  • The “medicine” of food insecurity: how food insecurity causes and exacerbates many chronic diseases, by physician-researcher Dr. Seth Berkowitz from Harvard Medical School.
  • The range of USDA food and nutrition programs—the frontline against hunger and insecurity in the U.S.— with which non-profit hospitals can collaborate to further strengthen their impact on food insecurity in the U.S., by Under Secretary Kevin Concannon, with specific examples from Cleveland Clinic, Arkansas Children’s Hospital, and other visionary hospitals.
  • Examples of evaluation methodologies to demonstrate the impact of food system interventions such as mobile markets, by Dr. Kim Gans, University of Connecticut and Brown University. Evaluation plans and annual reporting of impact of specific activities and investments are required by the regulation. USDA Under Secretary Kevin Concannon visiting the Hartford Mobile Market
  • A case study of Hartford Hospital’s community benefit investment in a mobile market serving neighborhoods with the highest food insecurity rates, in one of Connecticut’s poorest urban centers by Kole Akindele, JD., Hartford Hospital and Martha Page, Hartford Food Systems.

The Connecticut Food Policy Council’s leadership in convening a forum that offered education and important networking opportunities provides a model for Food Solutions New England and food policy councils in our region to follow. The real potential of the ACA provision and IRS Final Rule that seek to strengthen the community benefit programs of tax-exempt hospitals needs concerted action at the local and state level whereby parties with resources, capacity and expertise can join together to get back to basics and bring nutritious food to all people. As is often said,

“Food is Medicine” and an avenue now exists for hospitals to play a role in making it so.

Presentations and all resource materials are available here.


Where Might Charitable Hospital Community Benefit Investments Make the Most Difference? Go Where the Kids Are!

Are we maximizing the potential of anchor institutions for community health improvement? Let’s start with schools and hospitals.

Kids farming - Farm to School

Photo courtesy of the National Farm To School Network.

Hospitals are being drawn into the sphere of public health practice. The regulatory and reimbursement policies of the Affordable Care Act require not only demonstrable community benefit, but also decreases in readmissions for certain illnesses (see Hospital Readmissions Reduction Program). Moreover, the harsh reality associated with treating patients with illnesses associated with the environmental, economic, and social conditions in which they live means hospitals are expanding their role to include the population health of their communities.

Those conditions, particularly malnutrition and food insecurity, are compelling physicians and hospital administrators to grapple with the need for nutritional assessments upon admission, early supplemental nutrition intervention, and discharge planning that includes plans and resources for access to adequate nutrition (a problem often associated with re-hospitalization). Sending patients home to the same conditions that made them sick, or worsened their illness, is not an option.

But how to address these conditions in the community at large? By responding to the IRS-mandated community health needs assessment as an integral part of a comprehensive, nonprofit business plan, charitable hospitals can join with community partners to significantly ameliorate the social and environmental conditions that exacerbate poor community and individual health.

The first candidate for a community partnership may be the public school system. For example, the under-enrollment of some school meal programs suggests that supports for outreach and perhaps transportation are needed. In my state, Connecticut, the number of children likely to go without a meal is 1 in 5; in many neighborhoods the ratio is higher.

Schools have a “captive” population that is already supported by infrastructure (meal service) and varying degrees of revenue (USDA and state reimbursement for meals for eligible children). School meal programs can be improved by community benefit programs in a variety of ways:

  • Further enhancement of nutritional quality (in addition to meeting minimum state and federal standards). Cleveland Clinic, for example, provides local public schools the professional help of its dietitians.
  • Add-on programs, such as family dinners and summer meals. An incremental investment from hospital community benefit programs could augment existing public revenue to expand and enhance the basic operation of add-on programs. Arkansas Children’s Hospital is leading the way with this type of innovation, using its own facility to do so.
  • Farm to School programs are well-suited to partnerships with charitable hospitals. These programs have made the greatest strides in improving not only the nutritional value of school meals, but in establishing education regarding food and agriculture that has long been missing in the curriculum.


The strong leadership at USDA welcomes these hospital–public school partnerships and is will help to facilitate them them. The data maintained by these publicly funded programs allow evaluation to demonstrate impact, which is a requirement for community benefit programs. Technical requirements that could seem to be barriers are not: USDA is making great use of regulatory flexibility.

Building on what works, with a little creativity and thought, makes sense as hospitals step more deeply into population health practice. Simply being able to care for their patients, without the detriment of social and environmental conditions that attenuate medical care, has become an imperative.


Fresh Advantage featured in the Boston Globe


“Nonprofit hospitals, which make up about 60 percent of American hospitals, have historically justified their tax exemptions from federal and state government by offering charitable services in communities where they operate. Community health clinics and free and discounted care for poor patients have been among their tactics. But most nonprofit hospitals have not been required to report in detail exactly what they are doing to help people in need. Measures to prevent disease have not been required. Many hospitals have aggressively collected overdue payments from low-income patients, a practice that is discordant with being deemed charities.

The Internal Revenue Service, not typically a target of praise, issued rules on New Year’s Eve that for the first time require nonprofit hospitals to curb such debt collection, and to evaluate every three years their communities’ health needs and report how they are acting to solve them — both by subsidizing treatment for patients in need but also by striking at the root causes of illness. The new rules encourage but do not require hospitals to help “ensure adequate nutrition,” prevent disease, and address socioeconomic and environmental factors affecting community health. It’s an open door inviting mission-driven hospitals to go beyond treating illness to tackle the underlying drivers of chronic disease, including inadequate access to healthy food. This is a mission worthy of their nonprofit status.

New England has been a testing ground for possible actions hospitals can take. In Massachusetts, the Attorney General’s office asks hospitals to voluntarily report how they are investing in community benefits. The office estimates that in 2013, the 52 nonprofit hospitals and health care centers in this state spent $591 million on community benefits, of which $72 million was spent directly on free and discounted health care for patients and the rest went to other community programs. (The passage of state health care reform in 2006 and universal coverage may have something to do with these hospitals’ choice to devote resources to efforts beyond offering discounted care.)

Holy Family Hospital in Methuen runs a prescription program for fruits and vegetables that gives some patients $1 per day per family member to subsidize buying fresh food at farmers markets. Jordan Hospital in Plymouth pays for a community dietician, Marcia Richards, who helped redesign public school lunches and labels healthy foods in local markets. Mass. General screens patients for signs of food insecurity and offers a food pantry. A forthcoming report from the nonprofit Health Care without Harm documents 80 food access programs that Massachusetts hospitals are investing in, and calls for further measures, such as matching food stamp dollars for fresh produce.

New IRS rules invite mission-driven hospitals to go beyond treating illness to tackle the underlying drivers of chronic disease, including inadequate access to healthy food.

Two Connecticut organizations, Fresh Advantage and Wholesome Wave, broker partnerships with hospitals to improve food access and make hospital cafeterias healthier; they pushed for the recent IRS rules.

Despite such programs, poverty, hunger, malnutrition and related diseases continue to scourge communities in New England and across the nation. It will take far more investment and far more leadership. As the Affordable Care Act is adjusted and the epidemics of diabetes, heart disease, and obesity spread, a reckoning with the skyrocketing costs of health care looms large. Government budget cuts continue to hack away at food subsidies for the poor, exacerbating these costs over the long term. This is a defining moment for hospitals to lead and live up to their charity status, which means fulfilling a role the government alone will not: helping keep patients out of the hospital and in their homes, with fresh food at the table.”

See the full article here.


Nutrition and the Tax Code

Nutrition and the Tax Code

By Hilary Seligman, MD & Marydale Debor, JD20wi34HZ

On December 31, 2014, the Internal Revenue Service issued the long-awaited final ruling implementing Section 501 (r) of the Patient Protection and Affordable Care Act of 2010 (ACA). This section of the Internal Revenue Code deals with the conditions hospitals must meet in order to retain their nonprofit health status.  In an exciting development, this new code directs attention to the elimination of “root causes of disease,” especially among medically underserved, minority, and vulnerable populations.

Pre-ACA, hospitals generally “justified” their nonprofit health status by covering the cost of “charity care” for the uninsured.  With the expected dwindling in the numbers of the uninsured, the IRS is now taking tighter control over how hospitals must give back to their communities in order to maintain their nonprofit status.

According to these new rules, non-profit hospitals must now conduct a community health needs assessment to identify “significant health needs” in the community. Examples of these significant health needs include financial barriers to care and community capacity for addressing “the need to prevent illness, ensure adequate nutrition, and address social, behavioral, and environmental factors that influence health in the community”.  Hospitals must then dedicate financial resources to address the needs uncovered in their community health needs assessments.

OK, that is kind of complicated.  But this is big news.  Nonprofit hospitals will now have to treat not only acutely ill patients in own hospital wards, but move out into the community to address the upstream factors that predispose people to disease in the first place, particularly in our most vulnerable neighborhoods.  Most nonprofit hospitals will likely do this by administering grants to organizations that do community work—like Kaiser is doing in their community benefit program.

For those of us working to address food insecurity in the US and to connect the dots between food insecurity and poor health, the inclusion of “adequate nutrition” as a factor essential for community health is an exciting development.  This encourages nonprofit hospitals to support, collaborate, and partner with food banks, farmers markets, and providers of home-delivered meals to bring healthy food access solutions into local neighborhoods.  EatSF is one such program that could benefit from the new IRS rules.  EatSF is a new project under Hilary Seligman’s leadership that provides weekly vouchers ($5-10) redeemable for fruits and vegetables to low-income residents in San Francisco with the ultimate goal of preventing disease by improving dietary intake.  Our first vouchers will be distributed in the next few weeks.  These types of innovative solutions that reduce barriers to healthy behaviors in the community are the best type of prevention.

We are thrilled that hospitals can now get “tax credit” for being a part of these community solutions.  And extend a big “thank you” to the work of the powers-that-be who made this new ruling a reality—including those tireless advocates who filed public comments to the IRS encouraging the “ensur[ing] adequate nutrition” language.  It is about time that lack of access to healthy and affordable foods in underserved neighborhoods became part of our public dialogue about health!

For more information about EatSF, email us at or contact Melissa Akers at For more information about the ACA ruling, contact Marydale Debor.

This blog was originally posted on Mission: Health Equity


“Access to Adequate Nutrition” Added to Nonprofit Hospitals’ Community Benefit Possibilities in ACA Final Ruling

PPACAOn December 31, 2014, the Internal Revenue Service issued the long-awaited final ruling implementing Section 501 (r) of the Patient Protection and Affordable Care Act of 2010 (ACA). This new section of the Internal Revenue Code increases the legal obligations of nonprofit hospitals to address community health needs as a condition of retaining their nonprofit tax status. The legislative intent is to direct attention to the elimination of “root causes of disease,” especially among medically underserved, minority, and vulnerable populations.

As outlined in the proposed rule, a community health needs assessment (CHNA) must identify “significant health needs” in the community. Examples given in the final ruling include not only financial and other barriers to health care but also “the need to prevent illness, ensure adequate nutrition and address social, behavioral, and environmental factors that influence health in the community” (emphasis added).

The language in the final ruling makes clear that the scope of the community benefit responsibility of tax-exempt (nonprofit) hospitals has increased to include the promotion of population health, rather than retaining a narrow focus on individuals’ access to and ability to pay for clinical care. This broadened scope of community benefit responsibility and the inclusion of “adequate nutrition” as a determinant of population health opens up exciting possibilities as these hospitals continue to develop their community benefit programs. Under the final ruling, nonprofits are encouraged to collaborate and partner with third parties in the community, such as food banks and farmers markets.

The final ruling specifies several requirements of the CHNA in addition to identifying significant health needs in the community. A CHNA must

  • Reflect community input and summarize written public comments received
  • Be widely disseminated to the public
  • Include an evaluation of the impact of any actions taken to address significant health needs identified in previous CHNAs
  • Identify resources in the community that could be harnessed to meet significant health needs

In addition to conducting a CHNA on a three-year cycle, the final ruling requires non-profit hospitals to create an implementation plan and to provide annual reporting of their implementation progress.

An implementation plan is to be attached to the hospital’s Form 990 in the year it is completed (alternatively, the URL for the web pages on which the hospital has posted the plan can be provided). Here again, the regulations seek to clarify that the implementation plan, like the CHNA, in its determination of “significant health needs” may describe interventions designed to prevent illness; ensure adequate nutrition; or to address social, behavioral, and environmental factors that influence community health. Like the CHNA, the implementation plan must be approved by the hospital’s governing body.

Annual reporting via the hospital’s Form 990 is also required. Reporting should describe how a hospital facility is “actually addressing” the significant health needs identified in the CHNA. As with the implementation plan, the annual reporting may be accomplished by providing the URL of the website on which the implementation plan is posted.

Fresh Advantage® is extremely proud of its role in having “ensuring adequate nutrition” included as a means by which nonprofits can meet their community benefit obligations. Without the advocacy of the many organizations (led by Fresh Advantage and Wholesome Wave) that commented on the proposed regulation, the additions specifically addressing “access to adequate nutrition” would not have been made. Given that food insecurity and poor nutrition are consistently linked with illness and chronic disease, regular access to nutritious food is mandatory for an improvement in population—and individual—health among Americans.

Section 501(r) of the ACA and the final rule’s new provision in the Internal Revenue Code take a great step forward by clarifying that the community benefit obligation is a form of social contract for public health in local communities. If the legislative intent of addressing “root causes of disease” is to be realized over time, the intended policy changes will need to be implemented with vigor and sincerity as hospitals engage with the communities they serve, beyond their own patient populations. Similarly, it will require that community stakeholders and interested members of the public create new forms of communication and partnerships with their non-profit hospital neighbors.

Please contact Marydale DeBor for information about how Fresh Advantage® can assist your non-profit hospital with conducting a CHNA or incorporating access to healthy food as part of a community benefit program that will meet the requirements of the final ACA ruling.





Hear Marydale DeBor at “Hunger & Health” Virtual Town Hall

If you missed hearing Fresh Advantage Director Marydale DeBor in the Virtual Town Hall on the intersections between hunger, nutrition, and health, you can listen to it here.

Elaine Waxman, Vice President of Research and Analysis at Feeding America, described Marydale as “leading the charge in integrating health care and disease prevention with the interest in better food.”

Marydale noted that change is coming to reimbursement for food-related Medicaid managed care practices. The social determinants of illness, such as food insecurity, will inform future reimbursement policy. State governments can negotiate with the federal government for waivers for food support, such as medically tailored food and home-delivered food for healing and recovery, to counteract health-related food insecurity issues.

In addition to Marydale, panelists included Hilary Seligman, MD, of the Center for Vulnerable Populations at the University of California, San Francisco, and David Just, PhD, of Cornell University’s Center for Behavioral Economics in Child Nutrition Programs.

The panel presented recent research on the relationship between hunger, food insecurity, and diet-related diseases such as obesity and diabetes and shared promising interventions that are both high-impact and low-cost.
Common Sense Solutions at the Intersection of Hunger, Nutrition, and Health” was presented by Feeding America on July 17, 2014.