Session Two

Health and Hunger in My Neighborhood

Anitra Ellis, NP, Family Nurse Practitioner, Coalfield Health Center Mark Linville, Chief Marketing and Communications Officer, Boone Memorial Hospital Courtney Reynolds, PA-C, Chief Operations Officer, Southern West Virginia Health System

West Virginia remains one of the unhealthiest states in the country . Can we address health inequities when we address hunger? Can we address hunger when individuals access health care? Can we build a two-way street to do both?

U.S. News and World Report’s Healthiest Communities Rankings ranks every county in the country. The population health category assesses access to care, healthy behaviors, health conditions, mental health and resulting health outcomes within communities. This year, West Virginia scored a little over 11, out of 100, in the population health category. This is a low score, making us one of the unhealthiest states in the country. Boone County scored a six out of 100. Lincoln County scored a nine out of 100, and Logan County scored less than five out of 100.

The work to improve the health of West Virginians in these three counties is an ongoing challenge.

Research shows that patient health outcomes are greatly influenced by factors outside of clinical care, known as social determinants of health, including economic hardships like food insecurity. It’s often suggested that medical providers screen for food insecurity, and if the patient identifies as food insecure, refer the patient to the necessary community services.

But how does this recommendation translate to the local level, knowing that counties are medically underserved, providers have limited time with patients, and importantly, often do not know where to refer patients if they identify as food insecure? What if there aren’t any community services? How would the provider know if there are food pantries or other programs that address food insecurity in their communities, when there’s no centralized source of this information available?

While these questions are complex and require a multipronged response, panelists agreed that communitybased collaboration is key.

Dr. Ellis, for example, volunteers at a food pantry in her community in Logan County. Her organization, Coalfield Health Center, has provided COVID-19 vaccinations at the pantry. Through this partnership, she cultivates vital relationships, and she also has an opportunity to talk to patrons about healthy eating. For her, the collaboration provides an opportunity to easily bridge the two systems. In addition, she finds working in the pantry is a great way to build a rapport with potential patients. It helps her become a trusted face within the community.

For Courtney Reynolds, also a medical provider, the community’s main pantry is less than a mile from the Southern West Virginia Health System’s central location in Lincoln County. Patients who identify as food insecure can be directed to stop by the pantry when leaving the health care provider’s office. She believes screening for food insecurity without a direct resource to refer a patient to shouldn’t be problematic, and it shouldn’t stop a provider from screening. That information should affect how the provider cares for and responds to the patient. Screening and talking to a patient about food insecurity and finding ways to access nutritious food, over time, is an excellent way to build trust and honesty between provider and patient.

Our third panelist probed a larger question: How can a health care system, not just a provider, address food insecurity?

Boone Memorial Hospital, which provides an array of services, and serves a larger geographic area, works to address food insecurity in the clinical and community setting but finds it challenging to locate those critical community resource providers in their service area. With many medical providers, can a hospital system recommend a protocol to refer patients towards existing community services without a centralized list of these services? As Mark Linville explained, “We need an established lead agency…a continuous, sustainable organization that we can depend on year-round” to identify and collaborate with the hospital.

Is it feasible that this can be a role played by one of West Virginia’s food banks on the county level? A WVDHHR office? A nonprofit willing to serve as the lead agency in its county? Would a state-funded pilot program help assess the feasibility of a statewide network?

Clearly, two-way streets at the intersection between the health care system and the food insecurity infrastructure are optimal when connecting patients to services that address the social determinants of health, or social services that can shepherd clients towards utilizing health care services. A centralized agency could do more than serve as collaborative referral support. In Boone, Lincoln, and Logan Counties, a high number of residents are insured by Medicaid. The Medicaid population is less likely to access preventive services, like annual well exams, than other populations. Coordinated campaigns that support and promote each other’s services could help ensure that residents hear consistent messaging that supports care for their health and overall well-being. For example, when an individual enrolls in Medicaid at their local WV Department of Health and Human Resource (WVDHHR) office, they can be referred to local health care organizations that accept Medicaid. The health care organization can screen and refer patients to local services. And importantly, all could have the same list of local agencies that address food insecurity. This centralized agency can ensure all points on this pathway have updated information.

The challenges to improving the health of individuals in this three-county area are many and complex. Often health problems stem from poor nutrition. Providers and health care organizations are acutely aware of these connections between good health and proper nutrition, and that food insecurity and lack of healthy foods are foundational, historical challenges affecting these rural communities. Perhaps more public conversations to shed light on the challenges and potential solutions can help facilitate a more collaborative approach.

Until then, each of these three health care organizations continues to address food insecurity and promote healthy lifestyles in their communities. For example, Boone Memorial Hospital runs a Healthy Lifestyle Program. Southern West Virginia Health System holds an annual FIT Camp for kids, and Coalfield Health Center is an active member of Wild Wonderful and Healthy Logan County. We should all play a part in promoting and engaging our neighbors to participate. Our community’s health depends on it.