Delivering Community Benefit:
Healthy food playbook

Making the healthy choice the easy choice

Montefiore Health System

Making the healthy choice the easy choice

Montefiore Medical Center - New York
From Health Bucks to improving bodegas, this medical center, located in Bronx, New York City, is redefining preventative care through its community health perspective.
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Takeaways

  • Bronx County, New York has an extremely diverse and health-challenged population. For several years running, the Bronx has ranked last among New York State counties in the County Health Rankings and Roadmaps. 
  • Montefiore Medical Center has a long-standing history of working with community and governmental partners to address pressing community health needs.
  • As part of its community benefit investment strategy, Montefiore’s office of community and population health carries out key programs focused on increasing access to healthy food:
    • Montefiore participates in Health Bucks, a fruit and vegetable voucher program run by New York City. Montefiore has a 98 percent redemption rate for the Health Bucks that they distribute.
    • The Montefiore Healthy Store Initiative helps bodegas in targeted neighborhoods prioritize healthy food options through investment, support, and education.
Hospital
  • Hospital Name: Montefiore Medical Center
  • Hospital Type: Private, nonprofit, major teaching hospital
  • Hospital Size: Large (1,536 beds)
  • Geographic area: Urban
  • System/Network: Montefiore Health System
  • Network coverage: Bronx County, Westchester County, and parts of Orange and Rockland counties in New York State 
Demograpahics
  • Hispanic/Latino (any race): 55.1%
  • Non-Hispanic Black: 29.3% 
  • Non-Hispanic White: 10.0%
Community
  • Community Health Needs Assessment region: Bronx County
  • Population: 1.46 million
Health indicators
  • Poverty: 27.9% of families, 43% of children
  • Obesity: 30.3% of adults, 13.4% of children
  • Diabetes: 14% of adults

Montefiore Medical Center, located in the Bronx — the northernmost borough of New York City — serves a culturally rich and diverse community. With nearly 1.5 million people in 42 square miles, the Bronx is the third most densely populated county in the United States. Within this small area, many distinct neighborhoods exist. The Bronx has both one of the poorest congressional districts in the country and affluent neighborhoods. Thirty-five percent of Bronx residents were born in other countries, and the county’s population includes “numerous groups with low-health-literacy, limited income, English proficiency, insurance or insurance knowledge.”

For eight years running, the Bronx has ranked last (62 out of 62) among the counties of New York State in the County Health Rankings and Roadmaps. Mortality rates for diabetes, heart disease, and stroke in the Bronx exceed both New York City and national levels, as do adult and child obesity rates. While data show improvements across the county and New York City as a whole, the prevalence of diabetes and obesity in the Bronx still exceed citywide rates (for diabetes 14 percent as compared to 10.7 percent citywide and for obesity 30.3 percent as compared to 24.7 percent). Along with high rates of diet-related disease and obesity, nearly one in five Bronx residents struggle with hunger.

Community health needs assessment: Priorities and process

  • Food and diet-related disease priorities:
    • 2013 CHNA: Prevention of diet-sensitive chronic disease and reducing obesity in children and adults
    • 2016 CHNA: Obesity and diet-related conditions including diabetes, hypertension, asthma and cardiovascular disease
  • Participation from food-based organizations in community health needs assessment (CHNA) process:
    • Food Bank for New York City as well as representatives from local food pantries, community supported agriculture organizations, and farmers market associations
  • How/why did obesity emerge as a priority?
    • Secondary data analysis and information gathered at community meetings consistently pointed to obesity and related health issues as primary community health concerns.
  • Key community indicators:
    • 35.8% of households receive Supplemental Nutrition Assistance Program (SNAP) benefits.
    • 30.3% of adult residents in the Bronx are obese as are 13.4% of children

Full Assessment: Montefiore Medical Center Community Health Needs Assessment and Implementation Plan 2016-2018

Montefiore Medical Center farmers market
A staff member of Montefiore Medical Center volunteers at the Community Farmers Marke (Montefiore Medical Center). 

Assessing health needs — and how to meet them

Community health needs assessment process

Montefiore’s community health focus is an integral and long-standing part of its work. The medical center is a major teaching hospital, affiliated with Albert Einstein College of Medicine, and is connected to an extensive network of primary and specialty care centers located across the Bronx. Its school-based health program is the largest public school primary and preventive care program in the United States. Montefiore is also the largest employer in the Bronx, a position which further drives its community commitment.

Over the last three decades, Montefiore has built strong relationships with a host of community and governmental partners working on community health initiatives. These partnerships reflect a concerted effort to address the persistent health challenges faced by Bronx residents, from the AIDS epidemic to obesity and chronic disease. The hospital’s office of community and population health frequently works with New York City Department of Health and Mental Hygiene and its district public health office both on health program initiatives and data collection efforts, for and outside of the community health needs assessment (CHNA) process. Montefiore also works with numerous community-based organizations and participates in coalitions, including #Not 62 Coalition — The Campaign for a Healthy Bronx. 

Montefiore’s CHNA is a product of collaboration with its partners. For the 2016 assessment, the department led a series of “Community Consultations” to collect primary data, through community-based meetings, that it then shared with hospitals for their reports. Eight such events were held in the Bronx. Montefiore also engaged with its facilities’ community advisory boards to identify health needs and appropriate service delivery for specific communities. The priority focus on obesity to address chronic disease resulted from both the data review and the feedback received via community conversations as well as the alignment with state and local priority areas, set forth in the New York State Prevention Agenda and Take Care NYC 2020, New York City’s health improvement plan.

Investing in solutions

Implementation strategy

Montefiore’s chosen interventions align with the New York State Prevention Agenda and complement broader, coordinated efforts at work in the community to improve health and to address health disparities. The chosen intervention strategies focus on the specific populations with the most significant health concerns. The hospital invests significant staff time and resources in healthy food access initiatives and in food and nutrition education activities.

“Montefiore has been doing a ton of work around various food strategies and now we're putting together a bigger consortium around healthy food availability across the Bronx and thinking through that more broadly. That gets done regardless of whether it's a community health needs assessment year or not.”

— Amanda Parsons, Montefiore Health System vice president of community and population health

Comprehensive approach

Montefiore’s community-focused efforts complement the hospital’s work, through its food service and clinical care initiatives, to promote nutritious diets and healthy food choices inside its walls. Montefiore clinicians have created a Cardiac Wellness Program centered on a plant-based diet, featuring vegetables, fruits, legumes and beans, nuts, whole grains, and dairy alternatives, and the food service department has incorporated dishes from this program into their patient and cafeteria menus. Patients and retail customers receive handouts on the benefits of plant-based diets. These efforts to promote healthful, plant-based meals are further linked to Montefiore’s greater sustainability initiatives and intention to reduce its environmental impact while promoting patient and community health.

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