Integrating a 2,000-Year-Old Idea Into 21st Century Healthcare to Address Health Inequity and Reduce Chronic Disease

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More than 2,000 years ago the Greek physician Hippocrates said, “Let food by thy medicine, and let medicine be thy food.” With the skyrocketing rates of chronic disease, it’s a sentiment our current healthcare system needs to actively embrace. For example, research shows that eating more fruits and vegetables can reduce the risk of death associated with cardiovascular disease by 4% for each additional serving of fruit or vegetable per day. Those who eat an average of eight or more servings a day are 30% less likely to have a stroke or heart attack.

When it comes to cancer and diabetes, the research is just as clear. According to the CDC, an unhealthy diet and being overweight or obese can increase the risk of all diagnosed cancers by 40%. The CDC also reports that the number of adults in the U.S. who’ve been diagnosed with diabetes has almost doubled in the past 20 years. Just as troubling is that one third of U.S. adults have prediabetes and more than 80% don’t even know it. 

If nutrition is so closely aligned with chronic disease, why isn’t more emphasis placed on helping individuals improve their nutrition? The answer isn’t as simple as telling patients to lose weight or stop eating fast food. The fact is that many individuals, especially those living in underserved areas or “food deserts”, simply don’t have as many healthy options. 

But that’s changing. More forward-thinking organizations like Nashville General Hospital (NGH) are integrating a “food as medicine” program—or a Food Pharmacy—into their traditional clinical programs. The Food Pharmacy at Nashville General Hospital is similar to a traditional food pantry in that it provides access to healthy food for individuals living with food insecurity. But the Food Pharmacy goes a step further by educating individuals about which foods best fit within their care plan based on their chronic conditions.

Khalela Hatchett, MPH and Director of Population Health at NGH, leads the program. “The American Academy of Family Physicians has a scale for food insecurity, going from low to moderate to high,” Hatchett says. “The Nashville area is in the high zone, which makes our Food Pharmacy program critical to our efforts to address chronic disease and to improve the health of our local communities.” 

The program is focused primarily on hypertension, diabetes, obesity, and oncology—all conditions that are highly prevalent in food deserts. “We have a full-time in-house dietician who works to identify and assess patients whose conditions or life circumstances make them good candidates for our Food Pharmacy,” says Hatchett. The Food Pharmacy at NGH is set up like a grocery store. “We walk the aisles with patients, educating them about how to choose and prepare food to manage their condition.” For example, a diabetic would learn about the importance of reducing sugar, processed foods, and unhealthy carbohydrates. A patient with cardiovascular disease or high blood pressure would learn about the importance of avoiding sodium and how to cook foods with healthy alternatives. Cancer patients would learn how to use food to maintain a healthy weight, which is critical for the body’s ability to tolerate treatment. 

“Our goal is to have 90% of all NGH patients screened for food insecurity and to identify those who may be helped through our Food Pharmacy program.” Khalela Hatchett, MPH and Director of Population Health at NGH.

In addition to in-patient care, dieticians work with case managers and social workers to make sure patients continue getting access to nutritious foods through community resources after they leave the hospital. This includes helping patients get access to post-discharge ambulatory care and then working with those providers to make sure nutrition is a part of the patient’s ongoing care plan.

Hatchett is currently focused on expanding clinical integration of the Food Pharmacy into hospital workflows. “We’ve already developed an electronic screening tool that connects to both the acute and post-acute electronic medical records.” Now the focus is on building out the infrastructure needed to improve data analytics, outcomes tracking, and reporting. 

Funding for the Food Pharmacy program has come from multiple sources, including nonprofits and grants from Amerigroup and Cardinal1,2, as well as an internal employee giving campaign where proceeds go to the Food Pharmacy. 

According to Joseph Webb, DSc, FACHE, CEO at Nashville General Hospital (NGH), nutrition is about preventable health. “We want to keep people from becoming high risk,” Webb says. “If we can control their diabetes from diet, we can keep people from having a stroke and ending up in the ED.” The Food Pharmacy is a part of the Webb Health Equity Model (WHEM), a “hub and spoke” healthcare delivery process founded by Webb based on the principles of evidence-based management (EBM). “Our goal is to bring wholistic, proactive healthcare and well-care to the individual where they live, one neighborhood at a time.” The Food Pharmacy is a foundational element of this effort.

1.https://www.grantsoffice.com/GrantDetails.aspx?gid=30313 

2. https://www.cardinalhealth.com/en/medical-affairs/medical-products/educational-grant-applications.html

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