Delivering Community Benefit:
Healthy food playbook

Empowering health through dignity and trust

Jean Parks: Food Club member at checkout with her fresh foods (Community Food Club)

Empowering health through dignity and trust

Spectrum Health Butterworth Hospital - Michigan
Community food club and a comprehensive produce prescription program prove that food insecurity and diet-related disease can be overcome through programs that empower and enable healthy choices.
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Takeaways

  • Kent County faces public health challenges related to rising obesity rates and mental health. Data shows disparities are compounded by issues of poverty, racism, and access to healthy food. 
    • Obesity has risen by 11 percent since 1993.
    • 1 in 6 people is living in poverty. 
    • 1 in 3 use food assistance programs.
    • Over 128 organizations with expertise ranging from food security to housing and seven health care facilities participated in a collaborative community health needs assessment process. 
  • Spectrum Health has made significant investments of staff time, in-kind resources, and grant funding to programs working to address food insecurity and diet-related disease.
  • Partnered with Access of West Michigan to run Nutritional Options for Wellness (NOW), a produce and healthy living prescription program.
  • Provides financial and in-kind support to the Community Food Club of Grand Rapids, an innovative membership-based community grocery store. 
  • The NOW program has been remarkably successful by all available metrics. In 2016, there were 231 participants. Of participants surveyed: 
    • 97 percent reported that their overall health improved
    • 70 percent reported fewer visits to the emergency department
    • 90 percent reported that they are cooking healthier for their families and friends.
  • The Community Food Club has welcomed 2,086 member households, for a total of 2,505 since opening in 2015.
    • Distributed an estimated $801,000 worth of food
    • Grew to become the single highest food distribution outlet within Feeding America West Michigan’s 40 county territory
    • Sold almost twice as much produce as a traditional grocery store, fruit and vegetables represented 35 percent of grocery items selected. 
    • After 12 months of membership, 79 percent of respondents stated: "My family and I eat more fruits and vegetables now." 
  • Spectrum Health was awarded the 2016 Foster G. McGaw Prize through American Hospital Association
     
Hospital
  • Hospital name: Spectrum Health Butterworth Hospital
  • Hospital type: Private, nonprofit
  • Hospital size: Large (1102 Beds)
  • Geographic area: Metropolitan (Grand Rapids-Wyoming, MI)
  • System/network: Spectrum Health System 
  • Network coverage: West Michigan
Demographics
  • White: 82.4%
  • Hispanic: 9.8%
  • Black/African American: 9.6%
  • Asian: 2.3%
  • American Indian: 0.4%
Community
  • Community Health Needs Assessment region: Kent County
  • Population: 609,544
Health indicators
  • Youth obesity: 1 in 4 middle/high-schoolers overweight or obese
  • Rising obesity trend: 11% increase since 1993
  • Poverty: 1 in 6 living in poverty (15.5%)
  • Food assistance: 1 in 3 (32.5%) use food assistance programs

Spectrum Health is a nonprofit, integrated health system in West Michigan that offers a continuum of care through the system’s 12 hospitals, a network of care facilities and physician practices that span 13 counties throughout West Michigan. Spectrum is West Michigan’s largest employer and is headquartered in Kent County in the city of Grand Rapids — Michigan’s second largest city.

Kent County is located on the Western side of Michigan’s lower peninsula, about 30 miles east of Lake Michigan and is comprised of 21 townships, five villages, and nine cities. A significant portion of Kent County’s geographic area is considered rural, however, most of the population resides in urbanized areas or urban clusters. 

The vast majority of Kent County residents are white (82.4 percent) and young people (24-54 years old) make up 41.2 percent of the population. Home to several colleges, universities and health care resources, Kent County fares relatively well when it comes to socioeconomic factors such as unemployment, education, and income. However, Kent County has experienced a recent steady increase in population resulting in a lack of affordable housing and growing housing discrimination. 

Kent County faces public health challenges related to rising obesity rates and mental health. The county falls short of national benchmarks when it comes to factors such as healthy food and violent crime. A closer look at the data shows evident disparities compounded by issues of poverty, racism, and access. This is true regarding food insecurity and access to healthy food. 

Amongst its many strengths, the community has a history of building strong partnerships and utilizing an asset-based approach to identify and leverage existing community resources to address community health concerns. These elements are evident in the innovative strategies Spectrum Health employs to address the pressing health needs in their community.

Organization of community benefit and community health activities

Spectrum Health has a system-level steering committee that oversees community health needs assessments (CHNAs) and guides the development of community benefit implementation strategies. This committee largely consists of staff members with roles and responsibilities within the corporate system that supports Spectrum’s health plan, medical group and 12 acute care hospitals, including the vice president of Spectrum’s Healthier Communities program, staff from human resources, corporate finance and others. At the system level, this committee determined all Spectrum hospitals would address “access to care” and one or two other priority health issues based on the needs of their respective community.

Each facility has a working committee that is coordinated by the hospital group president. This committee is responsible for defining what “access to care” means in their specific community and works together to select additional priority health needs and intervention strategies.

Members a coolers. Orlando and Bertha
Orlando and Bertha, Food Club members, consider their options and discuss their fresh food selections as they shop (Community Food Club).

Community health needs assessment: Priorities and process

  • Food and diet-related disease priorities:
  • 2014 CHNA - Obesity, poor nutrition
  • Participation from food-based organizations in CHNA process
  • Feeding America of West Michigan, Eastern Avenue Food Bank, Food Security Advocate, Our Kitchen Table, Kent County farmers markets, Access of West Michigan, and area restaurants
  • How/why did food issues emerge as a priority?
  • Multiple evaluations from credible sources, including the Kent County CHNA and national INVEST HEALTH initiative, reported high obesity and poor nutrition, especially in youth populations, as key areas for improvement
  • Key community indicators
  • Obesity rates in Kent County have been climbing steadily, up 11% since 1993
  • 28.8% of middle school to high school-aged youth are considered overweight, and 21.1% are considered obese
  • Less than one-third of middle school to high school-aged youth report eating the recommended daily servings of fruits and vegetables

Full assessment: Kent County Community Health Needs Assessment

Assessing health needs—and how to meet them

Community health needs assessment process

For over 20 years, government, hospitals, and a wide array of community organizations in Kent County have come together under the banner “Healthy Kent.” In 2013, Healthy Kent took on the role of convener for the second countywide community health needs assessment (CHNA), with the Kent County Health Department (KCHD) at the helm. The department convened over 128 organizations with expertise ranging from food security to housing and seven health care facilities, including Spectrum Health, to participate in a collaborative CHNA process. 

Health department staff members began the 2014 Healthy Kent CHNA process by reaching out to a list of key community partners, particularly nontraditional partners, and community sectors that were missing from the previous countywide CHNA process to establish a more inclusive process. 

Food-related organizations including Feeding America of West Michigan, Eastern Avenue Food Bank, Food Security Advocate, Our Kitchen Table, Kent County Farmers Markets, and area restaurants engaged in data collection, review and needs prioritization activities by participating in or supporting community health forums, community health surveys, and Healthy Kent Summit activities. This engagement led to a more comprehensive view of needs as a result of more expansive data collection with contributions from thousands of residents and multiple sectors of the community. 

An extensive data collection and analysis process was managed by an epidemiologist from KCHD with support from community organizations. A community health survey included questions about access, availability, and affordability of healthy food; nutrition and healthy skills education; diet-related diseases; and food insecurity. 

Community food system partner organizations played an instrumental role in survey success by conducting targeted outreach to their service recipients and collecting survey responses. Organizations working on food access and food insecurity participated in numerous community health forums to identify strengths, weaknesses and health concerns, thus ensuring that food-related elements were represented in the assessment of community health assets and concerns. 

Obesity and poor nutrition were among four priority health needs selected by the community and adopted across the board at each health institution participating in the collaborative CHNA.

Each institution determined which needs they wanted to address in their community benefit activities and how to do so. For Spectrum Health Grand Rapids hospitals, a focus on food was obvious. Obesity rates had been steadily increasing for over a decade and fruit and vegetable consumption among middle and high-schoolers was remarkably low. Furthermore, extensive past experience with food and diet-related programming made these strategic intervention points.           

“We thought that food security, obesity, and nutrition was something that was so fundamental, something that we definitely wanted to address and call great attention to.”

— Ken Fawcett, Spectrum Health vice president of healthier communities

Investing in solutions

Implementation strategy 

In response to the region-wide CHNA findings, Spectrum Health has made significant investments of staff time, in-kind resources, and grant funding to programs working to address food insecurity and diet-related disease in Grand Rapids, Kent County and beyond. Spectrum has partnered with Access of West Michigan to run a food pantry-based Nutritional Options for Wellness (NOW) program since 2004 and provides financial and in-kind support to the Community Food Club of Grand Rapids – a community partner piloting an innovative membership-based community grocery store model. 
 

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