Bridging the Gap Between Food Insecurity and Health

Zaida Ayala, Senior Nutrition Services Coordinator at Project Bread, recalls working with a client, a mother of three with a back injury who lives in a small apartment in Lynn. Because of her injury, she couldn’t work. Plus, she needed new beds and kitchen items. Project Bread connected her with a program that provides furniture and supplied her kitchen equipment and food card benefits.

“She expressed how deeply grateful she was and how relieved she felt knowing that some of their immediate needs were being met. She also mentioned how the kitchen items would help her cook better meals and provide healthier food for her children,” Ayala says.

Project Bread’s Healthcare Partnerships program combines our commitment to fighting hunger with the understanding that access to nutritious food is a critical component of health. Launched in April 2020, the Healthcare Partnerships program is a bold step to integrate food assistance into Medicaid. This pioneering approach acknowledges food insecurity as a social issue and a critical health determinant that requires immediate and sustained attention.

Dr. Snehal Shah, MD, MPH, who has worked with us since 2021, emphasized the importance of seeing patients holistically. “Food insecurity is often an indication or related to other stressors in people's lives, and that it's important for us to understand the whole picture of the child and family as we try to support them in the ways that we can as they deal with challenges or other life stressors.”

As of September 2024, nearly one in five households in Massachusetts is food insecure. The USDA defines food insecurity as “the limited or uncertain availability of nutritionally adequate and safe foods, or limited or uncertain ability to acquire acceptable foods in socially acceptable ways.” As we know too well, food insecurity leads to dire health consequences, perpetuating a cycle of illness that can impact individuals and families for years.

Dr. Shah has spent years caring for children at Boston Children’s Hospital, witnessing firsthand how food insecurity impacts young patients and their families. “Can we reduce food insecurity among our patients and families? Are there things that we can do to help mitigate the impact of food insecurity? Are there ways that we can help people think about food or feeding their families in the ways that actually make them feel good?” she says.

The doctor highlights the situation's urgency. “There are a lot of health conditions that are associated with food insecurity…Malnutrition is easy to think about, but then there are all these connections between food insecurity and emotional and behavioral health outcomes in adolescents, such anxiety and depression. In a family,  the stress that comes from food insecurity could affect parents and impact their ability to parent the way they want to parent. We know that food insecurity has been associated with diagnoses such as obesity in kids. So there are a lot of connections between health and food access.”

By embedding food security into the healthcare system, we can address both immediate nutritional needs and long-term health outcomes. Our Healthcare Partnerships program represents a mobilization of resources to do just that.

The roots of the Healthcare Partnerships program trace back to April 2020, when we launched a pilot initiative to address the food needs of vulnerable populations during the COVID-19 pandemic. As the public health crisis unfolded, it became evident that traditional approaches to healthcare were insufficient when patients were also grappling with hunger.

The 1115 Waiver enables the use of Medicaid funds for “non-medical” expenses to address two key social determinants of health: food insecurity and housing stability.  As one of the few programs of its kind in the nation, Project Bread’s model goes beyond simply providing food prescriptions. It offers comprehensive case management for eligible MassHealth patients who experience both food insecurity and housing instability.

Erin McAleer, CEO of Project Bread, often emphasizes the importance of coordinated care. "By integrating cooking resources, fresh food access, and nutrition education into healthcare, we're not just feeding people—we're reducing chronic diseases’ impact and lowering healthcare costs long-term. That’s the ultimate goal," McAleer says.

Our Healthcare Partnerships program creates comprehensive support systems that address the root causes of food insecurity and empower individuals and families. We offer a range of services designed to address the complex needs of our clients:

For people who are facing food insecurity, financial assistance is definitely helpful, but it doesn't always cover everything a person needs to make healthy food. So, Project Bread's Healthcare Partnerships program isn't like other nutrition assistance programs - our program is able to provide financial assitance in addition to services such as kitchen supplies and equipment.

As one former client explained, "I loved the kitchen equipment. It helped us a lot. My daughter loves home cooked meals, but I was always cutting corners with frozen foods. Now with kitchen supplies it's easier to make home cooked meals with fresh ingredients." 

Navigating the SNAP application process can be daunting, so our team of trained coordinators helps clients enroll in and maximize their benefits. This can significantly increase the resources available for purchasing food. 

Project Bread's Healthcare Partnerships program aims to provide services to people facing food insecurity that will continue to help them even after the program ends. One of the services the program provides is cooking classes. Former program participants have explained how helpful these classes were and that even after the program ends, they still use the knowledge they gained. We connected with one former program participant who shared with us, "I am eating healthier now. I have more fruits and vegetables, and I read the labels now, like sodium levels." 

At Project Bread, we value people's autonomy. In our Healthcare Partnerships Program, a Project Bread staff member connects with a client to discuss their barriers to food access and then provides tailored services to overcome those barriers.

This includes nutrition education through cooking classes and one-on-ones with registered dieticians. As one former program particpant explains, ""I liked how they actually listened. I told them how I experience my health issues and actually understand. They didn't put words in my mouth like doctors." By providing these types of tailored services, Project Bread is also able to respect the autonomy of each client. 

To ensure immediate access to food, we provide food benefit cards that can be used at hundreds of supermarket locations. This allows participants to choose foods that meet their personal and cultural preferences. By providing program participants with monthly grocery store gift cards, people are able to access healthy foods. As one former program participant explained, "I liked that I had access to a lot of healthy foods. Though I am still sick, the program allowed me to eat healthier."

Each of these components is rooted in the understanding that addressing food insecurity requires a multifaceted approach.

A hallmark of our Healthcare Partnerships program is the development of personalized six-month action plans for each participant. These plans are crafted after thorough assessments of individual needs, taking into account medical conditions, dietary restrictions, and personal circumstances.

Dr. Shah reflects on the significance of personalized care. “When I think about my patients that I take care of that are experiencing food insecurity, I think a lot about the other things that are happening in their lives that could also be affecting the health of the child. I feel like it's never one-dimensional.”

The impact of our Healthcare Partnerships program has been nothing short of transformative. Since our launch, we have helped connect over 17,000 food-insecure patients with essential resources. The outcomes we’ve observed speak volumes:

Our impact is echoed in stories from clients. Liliana Torres, Senior Nutrition Coordinator at Project Bread, tells us a story about a 62-year-old client who has type 2 diabetes and fatty liver disease.

“She started off very hesitant and afraid about her diagnoses, but gradually obtained control over them. She also became more interested in the topic of nutrition, and we would spend the whole hour talking about foods she likes and doesn’t like, healthy recipes, cooking tips, nutrition labels, fad diets, etc. It started to feel like we were just two people who are passionate and curious about food,” Torres says.

“Her A1c had dropped to 8.3 (down from 13) and was also able to maintain her weight. Her diet recalls were looking balanced and had lots of variety. She had found different grains and proteins she liked, which in turn helped her consistently make balanced meals. The kitchen items she had received from Project Bread were helping her cook more at home and try new recipes,” she said.
 

Our program is not only changing the lives of individuals but also the practices of healthcare providers. Clinicians like Dr. Shah have seen the benefits of integrating food assistance into patient care, ”We are honored to work with Project Bread in this transition to a supplemental benefit because we know that our patients will receive compassionate care and comprehensive, wraparound services to ensure families can access and prepare foods at home that could improve their health.”   

Healthcare professionals involved in the program have noted increased patient engagement and satisfaction. With 84% of clients expressing high satisfaction levels, it’s clear that this holistic approach resonates with those receiving care.

The success of the Healthcare Partnerships program hinges on collaboration—not only between healthcare providers and Project Bread but also among numerous community organizations and stakeholders. Through strategic partnerships with healthcare facilities, we’ve expanded our reach over 150 healthcare locations across Massachusetts. This broad network enables us to connect with diverse populations, ensuring that those most in need have access to our services.

As we look to the future, our vision for the Healthcare Partnerships program continues to grow. We’re committed to refining our model, expanding our services, and sharing our success with other states.

“These outcomes are a critical step to move this work forward, and they show that there is a scalable way to do this,” says McAleer. “The healthcare system represents our greatest opportunity to support people worrying about where their next meal will come from, and we have to look holistically at the barriers people face – there is more to it than just food distribution.

 In doing so, we aim to create a world where food insecurity is not just an afterthought in health discussions but a core part of public health strategy. Just as we would address any other health crisis, we must recognize that hunger is an issue requiring immediate, comprehensive intervention.