Fresh vegetables — and starts

A Dig Deep Farms employee speaking about the challenges she has overcome and how her work with plants is like therapy. (Terry Lorant)

Fresh vegetables — and starts

Eden Medical Center - California
In Castro Valley, fast food is ubiquitous, healthy food is expensive, and fresh food outlets are few and far between. One hospital-farm-Sheriff partnership is making a difference.


  • “Access to healthy, affordable food” was identified as the second highest priority health need in the community health needs assessment (CHNA) process
  • Community health needs assessment process and implementation strategies were focused on “communities of concern” which were identified as areas with the worst health outcomes 
  • In 2016, Eden Medical Center’s partnership with Dig Deep Farms helped them distribute 1,500 community-supported agriculture (CSA) bags to families in Ashland and Cherryland through partner organizations working with young people and also with people reentering the community from the county jail.
  • Hospital Name: Eden Medical Center
  • Hospital Type: Private, nonprofit                     
  • Hospital Size: Medium (130 beds)                    
  • Geographic area: Castro Valley, California in Alameda County            
  • System/Network: Sutter Health            
  • Network coverage: California and Hawaii    

(Alameda County unless otherwise noted1

  • White (non-Hispanic or Latino): 32.1%
  • Black or African American: 11.6%
  • Asian: 30.2%
  • Hispanic or Latino: 22.5%
  • American Indian, Alaska Native: 1.1%
  • Native Hawaiian, Other Pacific Islander: 1.0%
  • Minority:2 66%
  • Community health needs assessment region: 10 zip codes in Alameda County. The major cities in the hospital service area include Ashland, Brookshire, Cherryland, Fairview, Hayward, Russell City, and San Leandro.     
  • Population: 371,612
Health indicators
  • Adult obesity (Alameda County): 19.8%
  • mRFEI (CC range3,4): 5.0 - 37.5            
  • Living in poverty (CC range): 8.4 - 18.4%
  • Unemployment (CC range): 11.1 - 16.0%
  • ED Visits due to Diabetes (CC range):  293.5 - 455.7 per 10,000

Eden Medical Center (EMC) is located in Castro Valley, California which is the largest unincorporated community in Alameda County. The hospital first opened in 1954 and joined with Sutter Health in 1997, moving into a new facility in 2012. The hospital service area is defined by 10 zip codes that are home to more than 370,000 residents. Its western boundary is the San Francisco Bay. 

The service area is racially and ethnically diverse with all but one zip code being majority non-white or Hispanic or Latino. The median income ranges from $56,656 to $138,447. Given the wide range of socioeconomic conditions and health outcomes within its service area Eden Medical Center focused their community health needs assessment (CHNA) and implementation strategy on “communities of concern” where the health disparities were starkest.

Community health needs assessment overview: Priorities and process

  • Food and diet-related disease priorities: 
    • 2013 CHNA - a) Nutrition b) Health Literacy
    • 2016 CHNA - Access to Affordable, Healthy Food 
  • Participation from food-based organizations in CHNA process: food pantry focus group
  • How/why did food issues emerge as a priority?:
    • Lack of access to healthy food was consistently a theme in the qualitative data, especially when discussing root causes of high rates of chronic disease.
    • Qualitative themes listed in the CHNA included: Costs of healthier foods relative to fast food; Number of and availability of fast food restaurants; Limited availability of fresh food outlets; Stress as the main driver of poor nutrition; and Cultural influences on diet and nutrition. 
  • Key community indicators: 
    • Unemployment - All of the "communities of concern" zip codes have higher unemployment rates than the Alameda County rate of 10.3%
    • Diversity - The majority of residents in 9 out of 10 hospital service area zip codes are Hispanic or Latino or non-white
    • Food environment - “So you have a community that on every corner just about has liquor stores, but no fresh food” - Key informant

Full assessment: Eden Medical Center community health needs assessment

Assessing health needs

Community health needs assessment process

Eden Medical Center worked with Community Health Insights (CHI), a CHNA consultant, who had completed their 2013 CHNA and held a depth of understanding of their community and hospital system. In 2013, CHI identified “communities of concern” that had particularly poor health outcomes and were experiencing health disparities. The focus of the 2016 CHNA was to prioritize improving health within those communities. The consultant conducted the CHNA from start to finish, including the data collection, analysis, and prioritization process. 

The CHNA defines "communities of concern" as “geographic areas within the hospital service area that have the greatest concentration of poor health outcomes and are home to more medically underserved, low-income, and diverse populations at greater risk for poorer health.” 

Factors that were considered in the identification of these areas included the use of the Community Health Vulnerability Index, a tool that CHI adapted to determine the extent to which health disparities were present in a given geographic area. Communities of concern were also selected based on mortality and morbidity rates. 

The analysis brought four zip codes to the front as "communities of concern" that represented about 55.3 percent of the total hospital service area. These zip codes were geographically at the center of the hospital service area and clustered together. The findings from the secondary data were confirmed by key informants (including local community health experts and service providers) who identified the neighborhoods associated with the four zip codes; Ashland, Cherryland, and San Lorenzo, as highest need: 

According a key informant in the 2016 CHNA, “The immediate surrounding area of Sutter Eden encompasses the unincorporated areas. Many of those neighborhoods: Ashland, Cherryland, San Lorenzo, they have no mayors, no government, are very diverse, and (have) relatively low-income to very low-income populations.” 

Key informants also identified specific racial and ethnic groups within the communities of concern that were experiencing poor health outcomes, including “Hispanic/Latinos, African-Americans, Pacific Islanders, new immigrants with limited English skills, and undocumented residents,” and noted that African Americans were consistently the group with the most significant disparities in health. 

The significant health needs were identified based on quantitative and qualitative data collected by CHI and then analyzed using Robert Wood Johnson’s County Health Rankings Model. The health needs that were consistently at the top were reviewed for each community of concern and then prioritized based on coverage and intensity of the health need. 

Access to affordable, healthy food was identified as the second of nine priority health needs. The consultant used the Department of Agriculture Food Desert Maps and Modified Retail Food Environment Index (mRFEI) to demonstrate the food environment but the qualitative data really told the clearest story. 

“We still have a lot of young people that come in here and we are noticing that there are a lot of behavioral issues [that] result from the fact that they haven’t had anything to eat all day. We hear stories of young people who had a bag of Cheetos, went to school, got into a fight, came here, and still haven’t had anything else to eat.”

— Key informant (2016 CHNA)

Qualitative themes that came out in the assessment included: the ubiquity of fast food restaurants, higher cost of healthy food compared to fast food, and limited availability of fresh food outlets. 

Key informant and focus group participants consistently pointed to nutrition, limited health literacy related to nutrition, and unsafe living conditions limiting exercise, as contributors to chronic diseases in their communities. 

Investing in solutions

Implementation strategy

The implementation strategy was driven by the internal community benefit team at Eden Medical Center, building off of the strategy from the previous cycle with final approval by the Sutter Health Bay Area Board. The hospital proposed strategies to address five of the nine significant health needs, including access to affordable and healthy food. 

All of the strategies rely on strong relationships with community partners who are working effectively within identified communities of concern. The 2016-2018 implementation strategy was the first —  in the 10 years of available data —  to prioritize access to affordable and healthy food. 

In selecting the community partner for the implementation strategy, the community benefit lead looked to the existing strengths within the community, identifying Dig Deep Farms as an organization doing impactful work that could benefit from the support of a hospital partner. 
Eden Medical Center is one of 24 hospitals in the Sutter System, which has facilities in California and Hawaii. Every year, Sutter Health gives each hospital in their system money to donate to the food pantry of their choice. In 2016, a regional cluster of three Sutter hospitals including Eden Medical Center donated $12,500 to the Alameda County Food Bank, $12,500 to the food pantry at Davis Street Family Resource Center in San Leandro and $25,000 to the Contra Costa County Food Bank. In addition, they donated $10,000 to Loaves and Fishes in Contra Costa County to be used for their meal distribution program and their culinary arts education program that prepares high school students for careers in the culinary industry. 

Sarah Kirnon, Dig Deep Farms
Sarah Kirnon, manager of Dig Deep Farms, explains plans for the future of the farm (Terry Lorant).


End Notes
  1. For the purposes of this case study, specific Alameda County race and ethnicity data came from U.S. Census 2016 that was not included in the Eden Medical Center community health needs assessment. 
  2. The Eden Medical Center CHNA defined minority as Hispanic or non-white and presented this figure. The limitations section of the CHNA notes challenges in obtaining secondary data by race/ethnicity and at the sub-county level. 
  3. The term “CC Range” refers to the range of data for zip codes identified in the CHNA as “communities of concern” 
  4. These ranges were shown on a map in the CHNA (p.49, Figure 9)

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