Missouri Foundation for Health aims for 'systems change' to end food insecurity

June 1, 2023

Nonprofit zeroes in on issues at the root of hunger, such as racism and poverty


Policies to pay workers living wages and programs to distribute nutritious food that are supported by SSM Health and Mercy are in sync with a long-term initiative to address hunger being led by Missouri Foundation for Health.

The foundation earlier this year announced a 20-year commitment to transform Missouri's food system "in momentous pursuit of systems change." The foundation started in 2000 with the assets from the conversion of Blue Cross Blue Shield of Missouri from nonprofit to for-profit status. The foundation's mission is to eliminate underlying causes of health inequities, transform systems and enable individuals and communities to thrive.


Katie Kaufmann, senior strategist with Missouri Foundation for Health, is leading the initiative to transform the state's food system. She says the initiative was undertaken as part of an operational shift by the foundation. Instead of merely being a funder of programs designed to improve the health of Missourians, the nonprofit in recent years has focused on becoming a changemaker through its own work.

"We started really thinking about our role in this space and trying to diagnose the challenges within systems that hold Missourians back from achieving health," Kaufmann explains.

Among the challenges that the foundation identified is the food insecurity that affects 700,000 to 860,000 Missouri residents, or up to 14% of the state's population of about 6.2 million. To address food insecurity, the foundation has concluded that systemic changes are needed.

Using an 'intersectional lens'
In its press release about the initiative to change the state's food system, the foundation notes: "Food insecurity is ultimately an economic problem driven by the concentration of market and political power in the industrial food system, systemic and institutionalized racism leading to racialized poverty, and economic disinvestment in rural areas and places populated by marginalized groups."

Team members from SSM Health St. Joseph Hospital — St. Charles in Missouri hold up bags of fresh produce that were given out at a drive-thru event last summer. The hospital partnered with St. Louis Area Foodbank for the food giveaway. Credit: SSM Health

Kaufmann says the foundation is using an "intersectional lens" in its approach to changing Missouri's food system. She says that means it is looking at how a range of factors such as racism, poverty, health insurance coverage, transportation and corporate agriculture affect access to nutritious food.

Kaufmann notes that large health systems such as St. Louis-based SSM Health and Chesterfield, Missouri-based Mercy are already at the forefront in addressing food insecurity and its root causes in Missouri. They are doing that, in part, by employing workers at living wages and through programs to distribute healthy foods. Both SSM Health and Mercy made pledges in 2021 to raise the minimum starting wage for all of their workers to $15 an hour. The state's minimum wage is $12.

Among the food programs that SSM Health takes part in is one between the OB Care Center at SSM Health DePaul Hospital in suburban St. Louis and Operation Food Search. The program ensures that expectant mothers and their families have access to healthy food and other necessities throughout their pregnancy.

Mercy, in collaboration with Operation Food Search, operates Fresh Food Market, a 12-week program in which adults with hypertension or diabetes can try out new recipes and select nutritious foods at no cost. Mercy also is working with nonprofit Food Outreach to offer medically tailored meals to people who are food insecure and have Type 2 diabetes.

Addressing social ills
Dr. Alexander Garza, chief community health officer at SSM Health, joined Missouri Foundation for Health's board of directors in January. Garza says he strongly believes that improving the overall health of communities requires focusing on access to nutritious food and other social determinants of health.


"If you think broadly about what are those issues that impact both the health of the individual and the health of the community, it is predominantly things that are outside of the health care delivery system," Garza says.

He says his experience leading SSM Health's community health work in individual markets will shape his advice for the wider efforts the foundation is undertaking.

Garza supports the thinking behind Missouri Foundation for Health's food transformation initiative that bringing about change will require a broad approach that addresses poverty, racism and other social ills. In St. Louis, for example, he points out that neighborhoods with high food insecurity rates often are the same ones that have been hit hard by economic disinvestment. He also notes that those neighborhoods tend to have large concentrations of Black residents.

"That isn't to say there's not need in other communities, but (in Black communities) this is much more structural and much more profound," he says.

Pandemic lessons
Garza sees lessons from the nation's response to the COVID-19 pandemic that could inform the initiative. One example is the national program that provided free school lunches to all students. That happened through federal funding during the first two years of the pandemic, ending the stigma of being part of a program just for the poor as well as administrative hurdles to accessing it.

A woman selects items from the Fresh Food Market that Chesterfield, Missouri-based Mercy stocks in collaboration with Operation Food Search. The market, housed at a Mercy clinic in Ferguson, Missouri, is part of a 12-week program for adults with hypertension or diabetes who are dealing with food insecurity. Credit: Mercy

"Any policy that we can enact to improve access to healthy food, especially for the more vulnerable populations, is a good thing," Garza says.

SSM Health, he notes, has made food insecurity a key performance indicator across the system for 2023. It has asked each of its regions to come up with a plan to address the need among patients. The plans vary, he says, based on community needs and resources, but all involve working with local partners such as food pantries.

Community outreach
To start the initiative that the foundation is committed to working on for two decades, Kaufmann says the foundation's staff is visiting communities across the state to hear from various stakeholders, such as people struggling with food insecurity, advocates who are trying to help and small farmers who can't get their products to consumers.

Kaufmann says the foundation also is studying how two major food safety nets — the Supplemental Nutrition Assistance Program and the Special Supplemental Nutrition Program for Women, Infants, and Children — are administered in Missouri. One question the organization and others it works in partnership with hope to answer, she says, is whether the enrollment and renewal processes are factors in why many people eligible for the programs aren't on the rolls.

"We're very early in this work and we're really trying to learn from individuals and from communities around the state," Kaufmann says. "I certainly hope we'll be able to come back in a little bit of time and say, 'We've made these investments and we've seen this sort of progress.'"


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