Common Sense Solutions at the Intersection of Hunger, Nutrition, and Health

Transcription

1 Common Sense Solutions at the Intersection of Hunger, Nutrition, and Health July 17, 2014 PARTNER LOGO

2 Contact Lisa Davis Senior Vice President of Government Relations Eleni Towns Federal Legislative Assistant PARTNER LOGO

3 Panel Hilary Seligman, MD, MAS, University of California San Francisco, Center for Vulnerable Populations Marydale DeBor, JD, Fresh Advantage LLC, Founder and Managing Director David R. Just, PhD, Cornell University, Center for Behavioral Economics in Child Nutrition Programs 3 INSERT NAME OF PRESENTATION PARTNER LOGO

4 Hilary Seligman Associate Professor of Medicine and of Epidemiology and Biostatistics Center for Vulnerable Populations at San Francisco General Hospital & Trauma Center, University of California San Francisco 4 INSERT NAME OF PRESENTATION PARTNER LOGO

5 Hunger vs Food Insecurity Hunger: The uneasy or painful sensation caused by a lack of food, or the recurrent and involuntary lack of access to food Food Insecurity: The limited or uncertain availability of nutritionally adequate and safe foods or ability to acquire acceptable foods in socially acceptable ways

6 Coping Strategies to Avoid Hunger Eating low-cost foods Fewer F&V More fats/carbs Eating highly filling foods Small variety of foods Avoiding food waste Binging when food is available Higher risk of chronic disease, such as obesity & diabetes Once you have chronic disease, poorer ability to manage it effectively

7 Diabetes as an Example Epidemic of diabetes in the US Increasingly a disease of the poor Diet is a cornerstone of management We can easily measure the effects of dietary changes Blood sugar goes up when diets are rich in refined sugars, grains, and starches Blood sugar goes down when meals are skipped or reduced in size Both of these conditions can be dangerous

8 Food Insecurity & Diabetes Food Insecurity Worsening of Competing Demands -Affordability of healthy foods -Episodic food availability -Stress Increased Health Care Utilization & Expenses Poor Diabetes Control Increased Diabetes Complications Adapted from Seligman & Schillinger

9 Links Between Food Insecurity & Chronic Disease Food affordability Episodic food availability Bandwidth

10 Affordability of Healthy Foods Time for Preparation Fear of Food Waste Equipment for Storage & Preparation What is affordability? Poor Quality Time & $ for Travel to Full-Service Store Variety

11 Diabetes, Food Insecurity, and Dietary Intake Food Insecure Food Secure Difficulty Following a Diabetic Diet 64% 49% Fruit, Daily Servings Vegetables, Daily Servings Seligman, Diabetes Care 2012; Lyles, Diabetes Care 2013

12 Dietary Intake & Health Increased consumption of caloricallydense foods (refined grains, added sugars/fats) Weight Gain/ Obesity X Diabetes Reduced intake of fruits & vegetables X X X Bhattacharya, 2004; Kendall, 1996; Olson, 1999; Tarasuk, 2001; Tarasuk, 1999; Dixon, 2001; Lee, 2001

13 Links Between Food Insecurity & Chronic Disease Food affordability Episodic food availability Stress

14 Food Insecurity & Disordered Eating Practices Binge eating Hoarding Food obsessions Extreme avoidance of food waste Strong preferences for highly filling foods

15 Cycles of Food Adequacy and Inadequacy High Blood Sugar Low Blood Sugar Seligman HK, Schillinger D. N Engl J Med 2010;363:6-9.

16 Admissions Attributable To Low Blood Sugar Among Patients Ages 19+ To Accredited California Hospitals On Each Day Of The Month, By Income Level, % increase in hypoglycemia admissions during 4 th week of month (compared to 1 st week of month) for low-income group only, p<0.01 Seligman H K et al. Health Aff 2014;33:

17 Cycles of Food Adequacy and Inadequacy High Blood Sugar Low Blood Sugar Seligman HK, Schillinger D. N Engl J Med 2010;363:6-9.

18 Food Insecure Adults with Diabetes Have Higher Average Blood Sugars Food secure (n=354) Food insecure (n=296) % <= >11 HbA1c Seligman, Diabetes Care, 2012.

19 Links Between Food Insecurity & Chronic Disease Food affordability Episodic food availability Bandwidth

20 Hunger Takes Up a Lot of Brain Space Less space left over for: Registering/re-registering for benefits Applying for/maintaining employment Taking care of health needs Parenting children

21 Adapted from Seligman & Schillinger. Food Insecurity & Diabetes Food Insecurity Novel access point (clinic or community) Worsening of Competing Demands -Nutrition -Eating Behaviors -Decreased bandwidth Increased Health Care Utilization & Expenses Diabetes & Poor Diabetes Control Diabetes Complications Traditional intervention (clinic)

22 Community-Based Diabetes Programs ***Key Point: Clinics have had a challenging time engaging many people with diabetes, especially the most vulnerable Food pantries offer another point of engagement: friendly, familiar, neighborhood oriented, and already associated with food

23 Thank You

24 Marydale DeBor Founder and Managing Director Fresh Advantage LLC 24 INSERT NAME OF PRESENTATION PARTNER LOGO

25

26

27

28 Sample 2013 CHNA Adapted from Kaiser Permanente

29 Community Benefit: Use of Hospital s Own Assets Addressing Elder Malnutrition Reduce re-admission risk Senior Suppers in Hospital Cafeteria (plowtoplate.org, others have replicated)

30 Change Coming From.. Multi-Sectoral Collaboration Hospital Sector: Stakeholder Group/Public Health Institute Philanthropic sector: Convergence Partnership Reimbursement PolicyRe: Social Determinants of Health (food, housing ) to reduce readmission rates, ER visits Medicare,Medicaid Governmental sector: CDC Grants key off CHNA process Private Payors Food as Medicine Report: Center for Health Law Policy, Harvard Law School

31 David R. Just Associate Professor Co-Director, Cornell Center for Behavioral Economics in Child Nutrition Programs Cornell University 31 INSERT NAME OF PRESENTATION PARTNER LOGO

32 Potential of Behavioral Economics to Help Promote Healthy Choices

33 How Do We Know What to Choose? 285 variety of cookies, 75 iced teas, 230 soups, 175 salad dressings, 40 toothpastes, etc.. 33 INSERT NAME OF PRESENTATION PARTNER LOGO

34 10 Spanish and English Floor Stickers (6 ft long by 3 ft wide) Placed Throughout the Grocery Store.

35 Why?: Economics and Psychology One reason is an inability to make reasoned decisions Individuals make food decisions a day Making deliberate decisions for each would be impossible We fall back on rules of thumb and habit What would happen if we did rationally consider each decision? How could cognitively based policies engage the unthinking?

36 Why?: Economics and Psychology Reactance Rebelling against a threat to freedom Fat tax versus a thin subsidy Limits on ketchup Attribution I chose it, I own it Carrots and Celery

37 Grams What is normal anyway? Soda can 12 oz Starbucks Tall 12 oz McDonald s soda child 12 oz McDonald s coffee small 12 oz Consumers presented with two sizes of items Regular and Double Half and Regular 140 more calories just by naming it smaller Spaghetti Waste Salad Waste Pudding Waste

38 What We Know About Food Decisions Two types: Cold State Rational Hot State Impulsive Stress and distraction lead to HOT STATE decisions It takes effort and resources to resist must be proactive

39 Hot/Cold Study Behavioral Interrupt Upstate NY schools with preordering of lunch items through SmartBoards Students who did NOT pre-order (Hot State): 11.8% less likely to take a fruit 8.9% more like to take a snack food 25% more likely to take a starchy side

40 What Works? Smarter Lunchrooms Move the fruit Name the healthier foods Signs and verbal prompts Place white milk so it is more visible than other options Less than $5 per school--one time fee