BY: ROB CASALOU
Illustration by Larry Moore
It's no secret that chronic conditions such as diabetes and heart disease are on the rise, with obesity affecting roughly 93 million U.S. adults, according to the Centers for Disease Control and Prevention. In addition to causing premature and preventable death, the annual medical cost of these diseases is driving health care spending to 18 percent of the gross domestic product in the U.S. This kind of rise is unsustainable.
Beyond the economics, as health systems, we are in the business of delivering care to enable people to lead their healthiest lives. Health professionals should be prime examples of health and wellness. In actuality, health care workers are some of the unhealthiest people in the U.S., often struggling with poor diets, high stress levels and low activity rates. What message does this send our patients?
At St. Joseph Mercy Ann Arbor in Michigan, we decided to start with ourselves to demonstrate firsthand that healthy eating can serve as the driver to a healthier lifestyle, improving personal health and overall wellness. Food, as they say, is medicine.
To that end, we set aside 25 acres of open land on the hospital campus to start a farm. The Farm at St. Joe's serves as the heart of our wellness initiative, a place to grow a healthy community and catalyze positive changes to the ways we live, eat and restore ourselves. The Farm serves as a hub where we, as individuals within a health system, can connect with our staff and those in the community to promote both individual and community health "from seed to stomach."
At the time the Farm started in 2010, St. Joe's didn't realize we would become the first hospital-based farm in the country. We just wanted to develop a program to address the root causes of chronic health issues, particularly obesity, by growing healthy food for patients and staff. Over the years, the Farm became so much more.
First and foremost, the Farm is a place where staff, physicians and community members can come and volunteer to garden in the hoop houses, either by themselves or as a team-building exercise. They harvest produce from the hoop houses, similar to a greenhouse, and then head over to the on-site teaching kitchen to cook and eat lunch together.
Later, these same people have been known to approach our full-time farmer for another recipe or to learn how to properly hold a chef's knife — further knowledge gleaned on their journey to better health. Some even reserve their own personal garden plot at the Farm that they tend over a season, planting and growing a variety of crops that appeal to them.
Since health care has been well-documented as a high-stress industry, these wellness retreats and cooking sessions address burn-out even as they educate providers on the concept of food as medicine for both themselves and their patients. We designed formal wellness curricula for medical residents who take a course on nutrition and healthy lifestyles as part of their residency program here. In addition, we host dietetic interns from local universities who complete one of their rotations on the Farm, gaining important hands-on experience on the origins of food. These interns then complete a clinical rotation that allows them to apply this learning to create the meal plans patients receive upon discharge.
Regular volunteers — from middle schoolers to retirees to special needs students — all experience the value of a visit to the Farm.
Soon after it opened nine years ago, the Farm began a weekly farmers market in the hospital lobby held during patient discharge and lunch time, to make the produce easily accessible to staff and visitors. Produce from the Farm also is served on in-patient meal trays and in the hospital cafeteria, often in the form of cherry tomatoes or fresh kale.
More recently, we started a Community Supported Agriculture, or CSA, program. More than 220 community members and staff take part in this "veggie subscription service" that runs for 36 weeks. Medical residents are able to use their meal stipend in the CSA program and pick up some fresh produce. And, thanks to grant funding, 38 food-insecure families all receive weekly bags of produce filled with popular items such as spinach and broccoli.
Through this collaborative program, we work with 10 local farmers to aggregate and distribute this produce to our CSA members. Not only does this enable us to provide a diverse array of produce, we are also supporting the local economy, changing the way people buy produce by favoring locally grown items.
Funding from this program has positively impacted local farmers, enabling one farmer to quit his job and farm full-time. CSA participants report increasing fruit and vegetable consumption by at least one serving per day with 95 percent reporting on a survey that they ate a greater variety of produce.
COMMUNITY OUTREACH AND EDUCATION
Although we are a working farm, our goal is not to grow large quantities of food. We know we can't grow enough produce to sustain the food service operation for our 537-bed hospital. What we do want is to grow a healthy community by promoting the consumption of seasonal, local produce through greater education.
The Farm's approach to education is to foster joy and discovery through inquiry and exploration of the natural world and food: how it is grown, cooked and contributes to health. Through our youth programming, we host field trips and summer camps comprised of a variety of hands-on farm activities that foster health and wellness. More than 87 percent of third graders who visited reported that they tried a new vegetable during the field trip and more than 89 percent understood that our bodies do not need sugary treats.
More specifically, our pediatric obesity intervention program called ShapeDown allows medically obese school-age children and their families to learn about healthy food production and recipes. Participants visit the Farm to see where food actually comes from, then take the freshly picked produce to the teaching kitchen to make a delicious meal. Many children who have never seen or tasted a carrot pulled fresh out of the ground have shared that simple experience has been life-changing when it comes to how they relate to food.
Several times a week, our dietitians provide a bag of farm-grown produce to patients being discharged from the hospital as part of the nutrition education they receive, further ensuring they continue their recovery at home fueled with fresh, healthy food.
Local sports organizations, including professionals such as the Detroit Red Wings hockey team, have come to the Farm to garden together and learn how to prepare healthier meals. Conversely, we are visible out in the community through our partnerships with these professional sports teams, in which we labeled the healthy food options available at their arenas and host on-site fitness events. We also work with the Eastern Market farmers market to bring fresh produce and nutrition education to underserved areas of Detroit.
THERAPY AND NUTRITION
One of our strongest partnerships is with the Eisenhower Center, a traumatic brain injury recovery group and residential center. Together, we built a clinically accessible hoop house designed for people of varying abilities, using raised growing beds and rehabilitation equipment to encourage gardening tasks such as watering plants. Residents from the center perform a variety of agri-therapy in the hoop house, then sell their produce and other items at the weekly hospital farmers market to gain useful work experience. The Eisenhower Center has seen significant progress with many of their clients, including lower rates of depression, fewer violent outbursts and increased self-esteem.
One of the most satisfying aspects of the Farm is that it enables us to put healthy produce directly into the hands of those who need it most. While a host of factors contribute to health disparity — poverty, access to fresh fruits and vegetables, lifestyle, and education — this is one way to directly address some of these social determinants of health.
Through our Produce to Patients program we deliver produce to 10 of our clinics that serve low-income populations dealing with chronic disease, such as diabetes and heart disease, as well as our Centering Pregnancy program for at-risk moms. In 2018, we provided 3,500 pounds of food to 3,300 patients through this program. We deliver fresh produce to these providers who then offer the food to their patients during their office visits — helping create a bond that also provides an immediate impact on patient health.
We work closely with local food pantries to distribute produce to people who are poor and have limited access to healthy foods. In addition, we work with the local health department to "prescribe" vegetables to those in need, who receive tokens redeemable for produce at our hospital farmers market each week. These collaborations provide both food and healthy recipes, creating pathways to better health.
Finally, the Farm is a way to treat social isolation. It brings people together with a common purpose — to grow, share and eat healthy food together. While struggles to maintain relationships and stave off loneliness have become a global concern, the Farm provides a community of volunteers and regular opportunities to cultivate purposeful relationships that improve health. Multiple events, such as the Farm's annual Luminary Walk and cooking workshops, not only encourage exercise and healthy eating but bring the community together. Volunteers report making friends, feeling like they are part of a family, and having an improved mood from spending time outside in the fresh air.
Although the Farm at St. Joe's began as a way to provide greater access to fresh produce to patients, staff and community, it has grown beyond that initial goal into a more mature program with a record of improved health outcomes.
Participants have been able to change their eating habits by eating a greater variety of fruits and vegetables and engaging in more physical activity. They have reported an overall feeling of a greater sense of satisfaction. We have made a difference to our community by increasing local food purchasing.
Other organizations are taking note of the impact this work has in the community, including our parent organization Trinity Health, Speckhard-Knight Charitable Foundation and Wash–tenaw County Health Department, which have provided generous grants to enable us to extend our CSA reach to more families in need. We have created a model that can be adopted throughout the country and welcome the opportunity to share what we have learned with other health systems.
This is what Catholic health care ministry is all about: helping those in the community improve their health and providing a space of comfort as we take this journey to better health together.
ROB CASALOU is president and chief executive officer of Trinity Health Michigan Region, overseeing the eight hospitals of Saint Joseph Mercy Health System and Mercy Health, its 10 outpatient health centers and more than 3,600 physicians and 20,000 employees across the state. More about the Farm at St. Joe's is at www.stjoesannarbor.org/thefarm.