How they can help fix our health and food systems

By Sarah Andrysiak

At the National Farmers Union convention this spring, a roomful of farmers listened attentively to Marydale DeBor, who was pitching a new idea.

“I am looking for you to be doctors to the world,” she said. A board member of the New England Farmers Union and delegate to the convention, DeBor has a vision for food’s role in health care: “Food is Primary Care.” It’s the tagline for her consulting company, Fresh Advantage (, which works with institutions nationwide to create health-driven and mission-aligned food service operations.

Indeed, good nutrition can help address many of our nation’s health challenges. A root cause of our poor health is a food system gone wrong: ubiquitous processed food laden with excess salt, sugar and fat, along with inadequate access to healthy food for many. Poor diet contributes to public health problems of obesity and related chronic diseases – diabetes, cardiovascular disease and cancer.

Health care organizations are under increasing pressure to address the health of the population. Many are starting to think that providing good nutrition, including access to healthy food, is part of the solution.

The Internal Revenue Service (IRS) is helping to accelerate this change in thinking. Nonprofit hospitals have long had to demonstrate to the IRS that they provide a community benefit in order to maintain their tax-exempt status. Historically, much of that benefit has come from providing care to people who couldn’t pay. However, with the expansion of insurance coverage under the Affordable Care Act, and provisions to strengthen how hospitals support public health, nonprofit hospitals must now find new opportunities for providing meaningful and effective community benefits.

In April, the IRS issued the Proposed Rule on Community Benefit Obligations of Nonprofit Hospitals, requiring hospitals to complete a Community Health Needs Assessment (CHNA). Hospitals must collaborate with public health experts and community stakeholders to understand the specific health needs in the region they serve. Then they must develop and implement a plan to meet those needs. A nonprofit hospital’s failure to provide community benefits could jeopardize its nonprofit status.

farmThe CHNA process, coupled with health care’s growing interest in healthy food, is sprouting a new opportunity for growers. Farmers in New England and across the country who are producing fresh and healthy food for local, regional and institutional markets can establish partnerships with nonprofit hospitals to help address the crisis that underlies obesity and chronic diseases.

Agriculture’s role
The IRS rule calls for the CHNA to address the “root causes” of the community’s health needs. Even the IRS language suggests that agriculture has a big role to play. What kinds of activities could hospitals undertake to benefit their community, improve health, and address the need for wholesome food?

Certainly there are opportunities for hospitals to provide financial support. Donations to community organizations have historically been used for community benefit credit. Yet the farm sector has not, until now, been considered as a potential recipient. With the dawning recognition of the importance of healthy food access and environmental health, hospitals should consider supporting organizations working to link farmers with local, regional and institutional markets. Also, by supporting the cooperative efforts of farmers to scale up, aggregate, or minimally process for the institutional market, hospitals could benefit their community by expanding in-hospital access to healthy food and supporting the local economy. By engaging in these activities, health care organizations would contribute to meeting the required community benefit threshold.

In addition, farmer training related to compliance with the Food Safety Modernization Act (FSMA) will be desperately needed once those rules are implemented by the Food and Drug Administration (FDA). With its impact on environmental health (good agricultural practices) and population health (foodborne disease risk), FSMA training is a logical community activity for hospitals to support and would qualify for community benefit credit.

In April, the organization Health Care Without Harm and the Catholic Health Association, a longtime leader in the field of community benefits, issued a draft report entitled “Healing Communities and the Environment: Opportunities for Community Benefit Programs.” The report, which lays out how institutions can work with community organizations and farms, can be accessed at

Meanwhile, in Burlington, Vt., Fletcher Allen Health Care reinvented its food service offerings. It now features a nationally recognized program to serve sustainably produced and organic food purchased locally whenever possible. Fletcher Allen also offers free public education on healthy lifestyles. The hospital spends approximately $1.5 million on Vermont-grown products each year, positively impacting health through diet and agricultural practices.

Strong food systems and access to healthful foods are now recognized as part of the solution to the problem of obesity-related chronic diseases, and farmers should be among the stakeholders participating in the CHNA process, urges DeBor, a lawyer with years of experience in health care administration and philanthropy. Agricultural practices also affect the environment, which in turn impacts health – another reason for farmers to be at the table.

As farmers, you can form partnerships with the nonprofit hospitals and public health organizations that operate where you live and work. Develop direct relationships with hospital officials and public health departments to learn how to participate constructively in this new CHNA process. A first step would be to approach your hospital’s CEO, board members and the personnel who handle community benefit programs (usually within the department of community relations). Start by building relationships. Invite these people to farm and food events in your community, where they can learn about agriculture and why it matters to human health.

It is a time of new ideas, when those who produce a fundamental element of human health – real, healthful food – must have their expertise embraced by the health care sector. Encourage hospitals in your area to step up their role in the local and sustainable food movement as a way to benefit their patients, employees and communities.

As health care and local agriculture work together to address our nation’s epidemic of diet-related diseases, we will not only improve public and environmental health, but also revitalize the local agricultural economy. We can bring health care and food production together for the benefit of all. The New England Farmers Union is supporting farmer efforts to engage the health care sector. Please visit and become a member today.

Sarah Andrysiak is a communications consultant for New England Farmers Union.

originally published Farming Magazine – July, 2013