The new battlefront in food insecurity fight

Spending 10 or 12 hours on University of Michigan-Dearborn's campus each day isn't unusual for Sara Alqaragholy, a senior studying urban and regional studies. But after paying for gas to get to campus, tuition and textbooks, midway through those days, not surprisingly, she often finds herself feeling really hungry. Sophomore year, as her family was enduring difficult financial times, affording even a snack, much less lunch, while she was at school was out of reach for her.

“I was working several jobs, on and off campus,” Alqaragholy recalled. For a few years she worked in the library on campus; in 2017 and 2018, she worked on voter registration drives, as well as holding down other jobs.

“To get gas in my car and to gain work experience, so just to get snacks while on campus,” she ended up tapped out financially.

She turned to the food pantry on campus.

University of Michigan-Dearborn started their food pantry on campus in 2013 after hearing from students that they could either spend their money on food or gas – but not both, said Brendan Gallagher, coordinator for civic engagement at U of M-Dearborn as well as director of the campus food pantry.

Gallagher, a former student on the campus who is now an administrator, was then one of the students who started the food pantry.

“We're largely a commuter campus,” he said, “with a very diverse community both religiously and ethnically. We have both a lot of first generation students and commuters.”

First generation students refer to students who are the first in their family to attend college.

Having a food pantry on campus, unfortunately, is no longer a unique attribute, but a necessary component to address widespread food insecurity among students, whether undergraduate or graduate.

“There are now food pantries at all 15 (Michigan) public universities, community colleges and many private colleges,” noted Jean Ann Miller, senior director of the Office for Student Involvement at Oakland University. “We only opened our pantry in October 2018. Like ours, most are primarily for students, but also faculty and staff. They're not open to the outside community. At ours, there are no questions asked – they just must show their student or faculty ID to ensure they're part of our Oakland University community.”

Since opening, there has been a steady flow of people accessing the food pantry, with some individuals becoming regulars, she said. “Now it's just getting the word out about the availability of this resource,” on campus.

Food insecurity, defined as being without reliable access to a sufficient quantity of affordable, nutritious food, is currently a situation that 12.3 percent of U.S. households experience. It's defined by the U.S. Department of Agriculture (USDA) as a household-level economic and social condition of limited or uncertain access to adequate food. According to 2016 research done by Susan Blumenthal, M.D. and Christina Chu, then with the U.S. Department of Health and Human Services (HHS), there are an estimated 17.5 million undergraduate students in America, 15 percent of which are enrolled in four-year colleges and living on campus. Twenty-five percent of students are over the age of 30, and 43 percent attend two-year institutions. As of May 1, 2019, student loan debt totaled $1.6 trillion, with an average household student debt of $47,671. Blumenthal and Chu determined that low-income students are more likely to drop out of college for financial reasons, such as not having the funds to cover living expenses associated with student life, including books, supplies, transportation, health care, clothes, housing and food, and it occurs at both four-year and two-year institutions.

A multi-state survey conducted by the University of Wisconsin of more than 33,000 students enrolled at 70 colleges in March 2017, found that as many as two-thirds of students were food insecure.

“Many students consider food to be their most flexible expenditure when determining where to cut expenses, which may be contributing to the alarming rates of food insecurity across college campuses in the United States today,” Blumenthal and Chu wrote.

“I think it's one of those hidden aspects of college life that's become more aware as costs are increasing,” Miller said. “Some students are choosing tuition and books over basic necessities, and the choice might be food. It's become an either/or.

“This is across the country, not just at our school.”

David Strauss, dean of students at Wayne State University, concurs.

“It's not just food – it's all basic needs,” he said. “With the increasing costs of tuition for college, it's food, shelter, clothing.”

Strauss said on the Wayne State campus, he has seen a big increase in student food insecurity in the last decade. “We weren't talking about this 10 years ago. We weren't talking about food insecurity, homelessness, basic needs challenges. Everyone was always having food drives for Gleaners (Community Food Bank of Southeast Michigan,) but that was for other people. Now we're having department food drives for our students.”

Strauss and other administrators at area schools of higher education emphasize the reason food insecurity and hunger is such a major issue – and pressing talking point – is because it can be a direct impediment to student success.

“If we look at student success, and we focus on student success and graduation, our number one goal is to get them across the finish line – and if we cannot get them nourishment, we can't help them succeed and across the finish line,” Strauss explained. “For many of our students, the question is, do I buy a textbook or food?”

“Hunger on Campus: The Challenge of Food Insecurity for College Students,” from October 2017, a production of the College and University Food Bank Alliance (CUFBA), National Student Campaign Against Hunger and Homelessness, Student Government Resource Center and Student Profile Interest Research Groups, found that 32 percent of students suffering from food insecurity reported it had affected their educational performance, with 55 percent of those students stating they did not have sufficient funds to purchase their required textbooks; 53 percent missing their courses; and 25 percent ending up dropping their courses.

Most food insecure students, 56 percent, are working; 75 percent of them receive some financial aid, including Pell Grants; and 43 percent are enrolled in a school meal plan. Food insecurity occurs at both two-year and four-year institutions, with 25 percent of community college students qualified as having very low food security (more severe levels of insecurity, where both the quality of food and the quantity is impacted), compared to four-year students. According to Hunger on Campus, food insecurity was more prevalent among students of color, with 57 percent of African American students reporting food insecurity, compared to 40 percent of non-Hispanic white students. More than half, 56 percent, of all first generation college students were food insecure, compared to 45 percent of students who had at least one parent who attended college.

Rachelle Bonelli, vice president of programs at Gleaners Community Food Bank of Southeast Michigan, said their food bank is part of Feeding America, and partners with three campus food pantries, Wayne State University, University of Michigan-Dearborn and University of Detroit Mercy, which began their pantry recently in 2019.

“It takes a while for word to get out, and for the stigma to lessen,” Bonelli said. She noted that food insecurity is higher at community colleges.

“If you don't have the money to go away to college, maybe you have to work,” she speculated.

Identified risk factors around low income students, Bonelli said, include being a first generation college student, a single parent – especially a single mother, homeless, had been a foster child when they were young, and had or currently have a disability.

“Any of those things increased the risk among low income students,” she said, pointing out that in Michigan, the cost per year for tuition and room and board to attend a public institution is now $21,823, and $33,489 per year for a private institution. “If you come from a low income household, where the poverty rate is about $20,000 a year for a family of four, how are you going to send your kid to school?”

Like Alqaragholy, the senior at U-M-Dearborn, the report noted that food insecurity is a problem for students who are employed, participate in a campus meal plan, or who seek other financial or material help, with 56 percent of food insecure students reported having a paying job. Of those employed students, 38 percent worked 20 hours or more per week. In order to qualify for Supplemental Nutrition Assistance Program (SNAP), formerly known as food stamps, a student must work a minimum of 20 hours a week in addition to attending classes, or have a dependent under the age of six.

Nationwide, 25 percent of students receive SNAP benefits.

“If students aren't eating, they're going to class, working part or full-time jobs, they're operating on fumes,” noted Raneisha Williams Fox, coordinator of student wellness at Wayne State University and the W Pantry, Wayne State's food pantry, which during the 2018-2019 school year gave out more than 8,000 pounds of food. It opened in April 2017. “In a week we'll see 25 to 28 students, and between 80 and 100 students monthly. Since we've opened we've serviced 1,500 students, and we've given out more than 20,000 pounds of food.”

She said they see both undergraduate and graduate students, with a mix of ethnicities, although “we're seeing more graduate students (right now), because I think – life. They tend to have more responsibilities – they have bills, higher tuition, household bills and responsibilities and they may have kids.” The W doesn't ask any financial questions nor screen anyone. “Just because you have a job doesn't mean you don't need help,” Fox pointed out.

It's also open twice a week during the spring/summer terms, “and even if a student isn't enrolled for spring/summer, but is enrolled for fall, they can still access it. Just because the semester is over, doesn't mean you won't be hungry.”

Fox said they have a caseworker through their Connor Service Center on the premises once each week to help individuals through the application process for state and federal benefits.

“That was an important aspect we began because many students don't think they qualified, and they do,” she pointed out. “Or that they didn't have time to apply. So this helps. It also dispels the stigma and the myth of who qualifies for assistance.”

She said they see more females than males. “I don't think there is a big difference, but I think more females are comfortable asking for help.”

Gleaners' Bonelli said they have SNAP benefits, or the ability to get people qualified for them, and they want to encourage individuals to become educated about them.

“Most able-bodied people between the ages of 18 and 49 enrolled in college are not eligible for SNAP,” Bonelli acknowledged. “Some come from means, are working, but when you realize that to get SNAP benefits you have to work 20 hours a week or are taking care of a dependent in their household under six, or participating in a work/study program or other workforce training program – so there are opportunities to be approved. But it is difficult to be a full-time student and work full-time.

“It's difficult for students to get on SNAP – it's ironic,” she said. “They should really be getting ahead. Their job should be studying.”

“What we're seeing now are the children of the (Great) Recession,” pointed out Wayne's Dean Strauss. “If we look at traditional students age 19, 11 years ago, they were eight years old. Instead of saving, (their families) were using that money to eat, pay housing, credit card debt. Today, we're seeing greater financial insecurity, mental health challenges and social media challenges. So many of our students are caring for their families. We hear of so many students using their financial aid money to care for their families (rather than for school). If they have an emergency, they have no credit, no money, and no one to turn to.”

Miller, of Oakland University, agrees. “This is a reflection of real life. You don't think how pervasive it can be in our communities, and it is an eye-opening reminder.”

“There are no questions asked” of those who utilize the pantry, opened in October 2018, or any of the other services offered to students and faculty. Of the variety of needs many recipients require beyond food assistance, she noted, “We're not a counseling center, but we offer a lot of resources, from transportation, housing, legal aid, information, for our commuter students so they can be successful personally as well as academically.”

The W pantry has a partnership with Gleaners, as does University of Michigan-Dearborn's food pantry, allowing them to purchase food at a discount. Oakland University does not at this time. The W offers both perishables and non-perishables, with 25 percent purchased from Gleaners and 25 percent coming from on and off-campus food drives.

Fox said that besides healthy and sustainable food, they also provide feminine hygiene products, toiletries, razors, gently-used household items and some school supplies.

“We are also teaching sustainability,” she said. “We have two nutritionists who are students, in the nutrition science program, who are creating recipes from items in our pantry, from staple items we always have. We noticed in the beginning students didn't know how to cook. They were getting healthy food but didn't know what to do with it.

“It's a collaborative effort,” she said, “so students aren't just coming in for food, but for nutrition advice and lessons as well, and they have access to recipes.”

Fox has a leadership team of 13 students who volunteer at the pantry. “It's students helping students – they can say, 'it's OK. I've used it, you can too.'”

At University of Michigan-Dearborn, Alqaragholy has turned her personal experience as a pantry client around and now volunteers there to help her fellow students in need.

“I oversee the restocking of shelves (which includes toiletries and feminine hygiene products also), making sure the pantry looks very nice for anyone coming in,” she said. “I really enjoy helping others. We are working very hard to meet the needs and wants of our recipients. We want our recipients to feel as comfortable as possible.”

She recognizes that many people feel a stigma or shame in utilizing a food pantry.

“Maybe it's my personality, but I didn't feel any stigma (when she used the pantry),” Alqaragholy said. “But I can see that for some others. We're built to think we should be able to take care of ourselves, and should be ashamed if we can't – and that's not accurate or right. There should be no stigma or shame.”

Since 2013, University of Michigan-Dearborn's pantry, which also is staffed and run by student leaders, has also worked with Gleaners, Brendan Gallagher said, “which allows us to purchase food and non-food items for pennies on the dollars. One of the challenges of that is when people ask how they can help, some donate food items, but I tell them to donate money because I can go out and stretch that money so much farther by going to Gleaners.”

Gallagher said he is developing a big fundraising campaign for next school year on that – as well as that they saw three times the number of students use the food pantry last year, “so if that continues, we will need to increase the dollars to help them all. Here at U-M-Dearborn, the food pantry is really supported monetarily, and by food donations, by the administration, staff, students and alums.

“We really see ourselves as a resource on campus like any other that is imperative to help students be successful and not have the lack of food be a barrier to being the best version of themselves.”

They also have begun to provide recipe cards to recipients, as well as educational demonstrations to teach how to read labels, what the difference is between “sold by” and “best use by” and are planning cooking demonstration on simple types of meals.

“We have the availability now to offer perishables, because the student government purchased a freezer/refrigerator for us,” he said. “We have a permaculture garden run by another administrator (on campus) that we have a partnership with, and we're offering fresh blueberries, strawberries, mint, sage. It's really taken off for students. It also provides a sustainability loop, where students are learning responsibility for giving, caring, learning healthy food choices and its sustainability.”

Figure being on a student meal plan will alleviate a student's hunger? Unfortunately, it doesn't, as most meal plans only are offered for dinners, or dinners and breakfasts, and many students run out of their meal points.

“Even meal plans for campus dining halls may not be effective prevention, as up to 43 percent of meal plan enrollees at four-year colleges report experiencing food insecurity,” reported Blumenthal and Cho. “Campus meal plans are structured to provide students with seven or 14 meals per week. Many low income students get their meals elsewhere because they lack funds to afford a comprehensive meal plan option. Students who opt for cheaper meal plans may not be eating an adequate number of meals; 46 percent of food insecure students report running out of meal points before the end of the term, compared to 33 percent of all students on a meal plan.”

Carmel Price PhD, MSW, associate professor of sociology, University of Michigan-Dearborn and lead for Michigan Food Pantry Network, specializes in research on college food pantries across the country and food insecurity amongst students. “We don't know if it's a new issue – I hypothesize it's not, it's just newly recognized,” she said.

“One of the reasons it's newly recognized is the (Great) Recession,” Price pointed out. “The conversations that we're having nationwide about equality and inequality, we're more openly talking about it, tuition increases, and the staggering increases in the cost of tuition. The conversations that we're also having nationwide about equality and inequality – we're more openly talking about it on campus. You have parts of society openly having conversations about income inequality and hunger, so there's more transparency.”

What Price said she does see as new is a greater proliferation of food pantries on campuses all over the country.

“When I first began looking into food pantries on college campuses, in 2014, there were about 140 across the country,” she said. “Today, five years later, according to the College and University Food Bank Alliance (CUFBA), there are about 700 registered. What you have is a new recognition that campuses are saying, 'We have a problem and we want to be part of the solution, and we're going to open pantries on our own campus.'”

The first campus-based food assistance program in the country was established in 1993 at Michigan State University with the Student Food Bank. “It was the first in the nation to be run by students, for students,” Michigan State said. In the course of a year, the MSU Student Food Bank serves over 6,000 students, many with families, and distributes over 110,000 pounds of food.

Almost 20 years after its own founding, in 2012, Michigan State University partnered with Oregon State University Food Pantry to establish CUFBA, which advises and supports campus food banks, with its goal of alleviating food insecurity and hunger on college and university campuses. There were originally 15 colleges registered. As Price noted, there are now over 700.

“Hunger and food insecurity on college campuses is not a new situation, but the recognition and the response with food pantries are new,” Price elaborated. “There were always professors with granola bars in their drawers and collectives.”

She said there is no uniform food pantry design or standards – they are as individual as the school.

“In our research, pantries look very different across the country,” Price said. “Each pantry makes it work for themselves. Sometimes they're housed through the health center, the social work office, or the student union. Sometimes they're run with academic involvement; sometimes they're run through student life. Sometimes they're student-driven; sometimes they're administrative-driven. I've seen pantries with walk-in freezers, and pantries operating out of a closet.

“One of the things we found in our research is how they differ from on and off-campus pantries. On-campus pantries are able to meet student needs that off-campus ones aren't,” she said. “Students feel more comfortable and feel less stigma going to one on their own campus versus a community pantry. Some students tell us they have been turned away from community pantries, versus campus pantries where they feel less stigma and feel more welcome.

“We have students who tell us they're able to stay in school because of their campus food pantry.”

Price said operating a campus food pantry has some unique challenges for universities that off-campus pantries don't encounter, from fighting for space, to food services viewing campus pantries as competition, to even having the financial aid office asking pantries to report the assistance they are giving to students – so they can count it against the student's financial aid package.

“We've been told pantry directors are sometimes wearing multiple hats at colleges, and may not have a background or training in food insecurity, whereas for an off-campus pantry, for that director, it was their career path,” Price explained.

But, “they have some unique opportunities to meet the needs of students and level the playing fields for students who don't have the financial wherewithal but also come with unique challenges in an academic bureaucratic environment, and they're doing it with very few resources,” she pointed out.

“The question still to be answered is to what extent are food pantries able to level the playing field of exacerbating inequality” on college campuses, Price said, which is the goal of her research long-term, as colleges “actually have the potential to exacerbate inequality, especially when a student has the potential to take an unpaid research opportunity or internship. But, if you're hungry, you can't take it, so when you graduate you have a worse resume than your fellow students, you have holes because you had to work and couldn't take internships. It's a myth college is way to pull yourself up by your bootstraps. You end up with higher debt.”

Obaidah Bitar of Bloomfield Hills, who recently graduated from Wayne State University, along with three friends and fellow civil engineer students at Wayne, recently designed six-foot tall food boxes that are food pantry installations designed for people to anonymously donate non-perishable food items, toiletries and hygiene items – as well as to access them anonymously.

So far, Bitar and his friends have built two, with the goal of three more in the very near future, which have been installed in religious institutions near the Wayne State campus. One is on the Wayne State Campus, at Forest and Cass. “It's on the sidewalk between two religious institutions, near the entrance of the university Islamic entrance and by a church across the street.”

Bitar said the four students were motivated by the homeless around campus, as well as his fellow students, including Bilal, one of the four creators.

“Bilal experienced food insecurity. His dad struggled to find a job; his brother went to school and he couldn't always eat lunch, and he really struggled in school,” Bitar said. “He is the most dedicated (of us) to service. They're doing well now (Bilal's family).”

Called “blessing boxes,” the white structures, six-foot tall by two-and-a-half feet wide, are made of durable wood to withstand various weather conditions. He said they have a shelf on top so anyone in the community can donate.

“We saw that food banks are open during work hours, 9-5, and not open on weekends,” Bitar said. “A lot of low income people don't have access to cars and transportation.”

He also noted that many people they spoke to were embarrassed to go to food pantries.

“People think it's a weakness, that they'll be judged,” he explained. “It's very difficult for them to put themselves in that role, especially if they know someone.” Hence the anonymity of the blessing boxes.

Another box is being built for Auntie Na's House, with another destined for the Downtown Synagogue. “We're talking to others as well. We hope to have five boxes built and installed by late 2019,” Bitar said.

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Health toll of food insecurity

Students are hardly the only segment of the population experiencing food insecurity, and colleges are just one segment seeking to ameliorate the problem. So too are health care institutions, many of which are analyzing the effects of food insecurity on their populations, and how best to help patients successfully access healthy and plentiful sustenance.

“Hospitals are very concerned about the social determinants of health,” said Rachelle Bonelli, vice president of programs at Gleaners Community Food Bank of Southeast Michigan, “which contribute to about 80 percent of health issues. A lot of your health is determined by 'do I exercise, do I eat healthy and have access to healthy food, do I have access to transportation?'”

According to the Centers for Disease Control and Prevention (CDC), the social determinants of health are the conditions in the places where people live, learn, work and play and how they affect a wide range of health risks and outcomes.

“We know that poverty limits access to healthy foods and safe neighborhoods, and that more education is a predictor of better health,” the CDC said. “We also know that differences in health are striking in communities with poor social determinants of health such as unstable housing, low income, unsafe neighborhoods or substandard education. By applying what we know about social determinants of health, we cannot only improve individual and population health, but also advance health equity.”

The Office of Disease Prevention and Health Promotion developed Healthy People 2020 to identify ways to create social and physical environments that can promote good health for everyone.

“All Americans deserve an equal opportunity to make the choices that can lead to good health,” Healthy People 2020 said. “But to ensure that all Americans have that opportunity, advances are needed not only in health care but also in fields such as education, childcare, housing, business, law, media, community planning, transportation and agriculture.”

Paramount among the objectives of Healthy People 2020 is the availability of resources to meet daily needs, both for safe housing and local food markets, and access to health care services. Several Detroit area health care systems have begun to address the social determinants of health by working to provide healthy food options for patients, both for sustenance, and to ascertain if it will help reduce the frequency of emergency room visits and admittance to their hospitals.

Bonelli said that Beaumont Hospitals have developed a food work group; however, repeated calls and emails to Beaumont were not returned.

Gleaners has developed a year-long study with Henry Ford Health System, called Henry's Groceries for Health, “where we've had significant reductions in our early indications of keeping people out of our ERs and decreasing their days in the hospital,” Bonelli said.

“Henry's Groceries for Health is a joint project between Henry Ford Health System and Gleaners Community Food Bank. It's aimed at addressing the very real shortage of nutritional food for many of the health system's patients in the Detroit area and its impact on the health of these individuals,” said David Olejarz, manager, media relations, Henry Ford Health System. “The program assesses the feasibility of food distribution to food insecure people, meaning those without a means to obtain healthy food on a regular basis, and its resulting effects on their health care – in particular, their need for emergency room visits, and hospital admissions.”

“We were testing whether providing enough nutritious food to our clinical patients would improve their health overall to measure success,” said Susan Hawkins, senior vice president of population health, Henry Ford Health System, as well as a board member of Gleaners. “Most of these patients have multiple chronic conditions and see their doctors frequently, but things happen overnight or on weekends.

“Our hypothesis was, take food – and the right kind and enough of it – out of the equation.”

The study – which Hawkins said was conducted as a full clinical trial – enrolled their first patient in November 2017, and the last in a 300-patient one-year trial in May 2019. Participants were patients within Henry Ford's Comprehensive Care Centers in Taylor and Detroit Northwest, and their Academic Internal Medicine Clinic at Henry Ford Hospital in Detroit. They had to live in a home with fewer than four people in order to ensure that there would be enough food to provide benefits. They also had to have the ability to store food properly and have the ability to prepare food, such as having a microwave, or ideally a stove and oven.

As part of the program, Gleaners delivered, or made available for pickup, food boxes every two weeks for a period of a year. Hawkins said they introduced the food boxes about six months into the program, “so people could choose their preferences while still getting healthy options and recipes. They became very popular.” Most participants chose to have their food boxes delivered.

“Each food box contains enough food to prepare 10 supplemental meals for the two-week period as well as recipes for preparing healthy meals,” Olejarz said. Participants also received a bi-weekly check-in from a Henry Ford Population coordinator who interviewed the participants to evaluate the quality and quantity of the prior food delivery and their experience.

They also measured blood sugar levels for people with diabetes, blood pressure, and weight and body mass, “because often people who are undernourished are overweight,” Hawkins pointed out. “It's a lot easier to get a $1 menu item than nutritious healthy food. We see a lot of people with heart failure, hypertension, diabetes, lung disease or COPD, mental health issues and depression.”

While the final study data will be completed later this summer, the preliminary data is extremely promising. Of the initial 300 patients in the study, they ended up with 280 patients, and a preliminary 68 percent had a reduction in inpatient involvement, and there was an over 25 percent reduction in emergency room visits compared to before they began receiving the food boxes.

Hawkins said for Gleaners, delivering food was a new endeavor, and they successfully recruited a driver who was consistent and stayed with the program, becoming very friendly with the patients. As for plans to continue Henry's Groceries for Health, she said, “We need to figure out the return on investment. Anyone who was a participant was referred back to Gleaners and their food pantries. Our goal is to create a full-on operation to scale up, but we still need to figure out the funding.”

At Detroit Medical Center's Children's Hospital of Michigan, pediatric hospitalists Dr. Sara Haidar and Dr. Chaya Pitman-Hunt, co-directors of Children's Food Insecurity Task Force, said they were both seeing patients where the symptoms of food insecurity were obvious.

“With some patients, the symptoms are staring at you in the face – failure to thrive, weight loss. In other situations, you have to dig deeper,” said Haidar. “A parent who is very angry – they've been in the hospital (with their child) for two or three days, and they're very, very hungry and can't afford hospital meals.”

About 18 months ago, the two said they were each looking at dealing with how best to address food insecurity, both for their patients and the parents of their patients, when they decided to join forces and develop the task force, where they now have medical students and residents working with them. They noted that one in five children in Wayne County is food insecure. Pitman-Hunt said that for children who live in a single family household, with a father, 20 percent are food insecure; those with a mother as the head of the household, 30 percent are food insecure.

In 2015, the American Academy of Pediatricians recommended that all pediatricians screen for food insecurity, and in 2017, they published a tool kit.

“Unless you ask, you won't be able to tell which child is going to bed hungry, and you won't be able to connect their families to resources, like SNAP, WIC (special supplemental nutrition program for women, infants and children), or food pantries, that will help get them food,” said Benard P. Dreyer, M.D., president, American Academy of Pediatrics.

There are two screening questions they recommend to see if there is hunger: “Within the past 12 months, we worried whether our food would run out before we got money to buy more;” and “Within the past 12 months, the food we bought just didn't last and we didn't have the money to get more.”

Patients screen positive for food insecurity if the response is “often true” or “sometimes true” for both or either question, the academy advised.

“A lot of people know patients are hungry, but it's a sensitive topic. We didn't have a good solution. We had to find partners, and it's difficult to connect the dots when they're in a clinical environment,” Pitman-Hunt said. “We partnered with the United Way, connecting patients to United Way's 211 call system. They have an anonymous call center, with family screening and help. They can address all different kinds of social determinants in order to make a more robust determinant.”

Pitman-Hunt and Haidar received a small grant request from the Children's Foundation, and developed a six-part lecture series this past winter.

“We wanted the staff to be knowledgeable about the social determinants of food security and what can be done to help,” Pitman-Hunt said. “We surveyed our providers, and 80 percent have concerns that their patients have food insecurities.”

As part of their project, they are thinking about developing a food pantry at Children's Hospital, but Haidar said it's not yet in development.

Gleaner's Bonelli said they want to create something at Children's for “low income parents whose kids have to stay for a long time.”

“In the public health realm, there are studies that show that families with food insecurity delay care, and we often see patients at a more delayed stage, which can have great implications for families,” Pitman-Hunt said. “In pediatrics, with the screening, we find families are often afraid, if they're honest, that their kids are going to be taken away from them, especially if their child is underweight. They're afraid they're going to be in trouble – we just want to help.”

The two are currently focusing their energies on training their colleagues to consistently screen and monitor their pediatric patients, and their parents.

“There are specific health repercussions of food insecurity, from delays in health, cognitive delays, mental and behavioral problems, increases in the number of hospitalizations, adjustment problems in adolescence and poor quality of parenting,” Haidar said.

“All of these efforts show that healthy food impacts health outcomes and reductions in health care costs,” Bonelli pointed out. Because of that, lots of hospitals are interested in setting up food pantries, she said.

No matter where food insecurity is encountered, “success begets success and investment,” Bonelli pointed out.