Good morning everybody. We are happy here to have two people from the University of Virginia I'm thrilled to have to speak with today because I want to share your good work with our audience. The first being Teagan Medico, and the second being Dr. Jeffrey Gander. Good morning. Good morning. Thank you so much for having us today here, Bill. I really appreciate it. Good morning Bill. Thank you very much. We are very honored and happy to talk about the stuff we're doing, but also how much fun we're having doing it. Let's start with Teagan. Teagan, tell us a little bit about what you're doing, the magic that you're doing at UVA. I want to hear about that. Can you share that with our audience. Sure. Well, first it's a big team efforts. I'm speaking on behalf of lots of people who are doing great work. What we have started doing about a year ago is thinking about child food insecurity and how we, as healthcare providers and health care organization at UVA can address this problem in our community. It was really inspired by just the observations of people struggling during the COVID-19 pandemic. It started off with a partnership with the Charlottesville local food hub with their fresh pharmacy programs. This is a program that they had already been doing where they were working with local farmers, collecting locally grown fresh food and delivering it to families. What we did is we started to screen for food insecurity at some select clinics that UVA identifying food insecurity and really referring families to this program. That was one side of what we were doing. Can I just ask you a quick question about that. I'm sorry to interrupt. You're a dietitian and that's how this is the department that you're in and you're collecting data. Did you collect the data? What did that look like? We haven't started collecting data yet, but that is one thing that we want to do. Yes, I'm a dietitian, I specialize in pediatric, so I'm everything. Nutrition, world tube feeding, intravenous nutrition, all of it, I'm involved with. Dr. Gander had approached me and one of my colleagues to get these initiatives off the ground. We actually didn't do any baseline data collection or any formal community needs assessment. It was just the sense that people who are struggling. We thought, well, why don't we go ahead and try to do some of these programs and see what happens. See if they're being used and see if we can expand. I love that. You were able to then connect the dots in the community to help people who were dealing with food insecurities should get the help that they needed. Can you for our audience, share exactly what food insecurity are. I thank you for that question because one thing that I learned is that everybody has a different idea of what this means and a different image of a food insecure person. Depending on what our preconceived notions are. One of the main definitions that you will find quoted over and over again in the literature around food insecurity that it is delimited or in certain availability of nutritionally adequate and safe foods or the limited or incertainability to acquire fluids in socially acceptable ways, that's the official definition. The USDAs, the US Department of Agriculture sub categorizes students security into two types. Low food security and very low food security. Low food security exists when households have to alter the quality, variety, and desirability of their diets. But the quantity of food intake is not yet affected. Very low food insecurity exists when the quantity of food intake is disrupted. I think it's important to emphasize here that reduced quality of the diet due to lack of resources is still food insecurity. Food insecurity is not starvation. Even with very low food security, reduced food intake doesn't need to be all the time. It can be intermittent and it usually is. I think people don't understand in mainstream America that they're countless children going home to empty refrigerators or empty counters. There isn't a family plan for getting food. I had a question about the impacts really on health and if you could share any of the information that you may have just off the top of your hand on, in food insecurity and a child's health, what does that look like? What are the impacts there? There are several associations with numerous negative health outcomes related to health development and actually health care access. These are associations always have to be little bit careful about questioning the mechanisms like are we dealing with the consequences of poor nutrition or are we dealing with other social determinants of health that coincide with food insecurity or maybe a little bit of both. But there's pretty good evidence to suggest that independent effectively insecurity on some outcomes, particularly those related to health care access. Delaying medical, dental, and mental health care, which in turn has really big implications for health outcomes. Wow, it really is, what you're doing now is really the most basic in making sure we can keep our children healthy. Can you share with me what a health care provider might do if there's suspect that, we don't expect every health care provider to be aware of every issue. Are there signs, are there things that they can do to say, "We're a little bit worried about this," or can they point to somebody? Is there an action step they could take? Yeah. Dr. Gander is going to talk a lot about some of the initiatives that we've done at UVA, and I do think that more and more healthcare organizations are considering things like produce prescription programs, meal delivery services for patients with chronic disease and even some onsite food pantries. I think we'll see more and more of that into the future as healthcare organizations become more innovative way and think about more innovative ways of servicing patients. But in the meantime, there's still a lot of concrete actions that the healthcare organizations and individual providers can take. One thing that we really emphasize is screening for food insecurity and this can be done in a pretty streamlined fashion. There's food insecurity screen, it's called the Hunger Vital Sign. It's two questions. It's validated and it can be done on intake. People come in for their appointments, they get us a bunch of questions. These can be two questions that can be integrated in there. Then if someone screens positive for food insecurity, knowing what resources are available, whether that's a national resource, or state resource, or even a lot of community-based organizations. We can talk about Charlottesville a little bit. Charlottesville has a very rich community of people and organizations very active in the food access space, so just knowing what they are and being able to connect patients to services that already exist is one simple option. There are website tools, there are phone number based-tools that can be provided to families, that they can just put in their zip code and learn about food resources hyper local to where they live. Because we know that transportation can also be a big problem, big barrier for a lot of people. I would say, one, screening people, identifying who they are, and then connecting them with resources that may already exist. Can you share with us what those two questions are? Can you tell us? Yes. They're very similar, so I always have to look them up real quick, make sure I'm saying the right thing. I expect that. The first question is, within the past 12 months, we worried whether our food would run out before we had money to buy more. It's a yes or no response. Then the second question is within the past 12 months, the food we bought just didn't last and we didn't have money to get more. Answering yes to either one of those questions is a positive screen. Got you. Okay. Then are there places that collect that data? Is there a clearing house where that information goes? Is that passed on beyond the patient, beyond the individual? Yeah. Not in a centralized fashion to my knowledge, but that's something that we're trying to do at UVA Children's. We've started screening on intake when kids come into our specialty clinic building, and so we are able to collect that data and run reports on it. When saying people don't think of that until they started hearing it more and more and more and I'm like "Wait a minute, this sounds like something bigger than an occasion" [inaudible]. That's why I was curious. I'm glad to hear you've started that process. I'm super grateful you're here today. Thanks for all your good work. I really appreciate it, Teagan. Doctor, would you please share with the audience your background, position, what you do. Can you share with us on that? Absolutely. I'm a practicing pediatric surgeon. I grew up in the Northeast in New Jersey and I went to medical school there and I did a surgical residency and then a fellowship in pediatric surgery at Columbia Presbyterian up in New York City. Then in 2014, I moved down here, Charlottesville to start my practice and to join the faculty. I also work at the School of Medicine, teaching students. My interests in food insecurity and helping people is just a lot had to do with how often I was seeing my own patients with similar problems. Just to interrupt a sec, can you tell us about your patients you would possibly you do have? Absolutely. My patients run from neonates, babies born premature really up until early adulthood, 18-21. I'm a pediatric general and thoracic surgeon, so that could be appendicitis or cancers, lung malformations, congenital malformations, gallbladder disease. It's pretty broad. But anyway, what I was noticing is that especially in my teenage population, a lot of them are overweight and kept coming in with similar weight-related issues such as gallstones, and that got me thinking about, how is there a way to prevent some of these diseases are happening but also to help them so that as they grow, get older, they have a long life ahead of them, that they're not going to be having chronic diseases such as diabetes, high blood pressure, sleep apnea throughout their whole life. In which you know, of course, we're always interested in lowering the risk for those illnesses because so many are a precursor to cancer. Dr. Graham Colditz from the Nurses Study at Harvard and now from Washington University in St. Louis had said that really cancer prevention starts very young, really with eating. I totally agree. American Cancer Society I think with our last paper we said at least a third of cancers are related to obesity and being overweight. It's a struggle. I myself have struggled with a lot of my life. It's really a struggle and it is a real culture investment. Yeah, I agree. Can you share with us how you connected the dots. You've got these kids coming in, they're sick. Is any of these preventable? You're probably thinking, what can we do to prevent this? We've gone to their refrigerators, we know there's several things we can do to prevent this, but go ahead. Was there a tipping point for the inspiration of this project? There was, I remember speaking with a 15 year-old boy after he had appendicitis, which is usually a fairly straightforward operation, but he was over 300 pounds and which made it much more challenging. In the after visit we were talking about, what are some healthy habits he can start to do? I said, Tommy, typically what do you eat every day? "I often skip breakfast and then I eat whatever the school lunch has which is pizza. Then I come home and my mom, sometimes will make something." I said, gosh, that's not an ideal diet to sustain you, but also to prevent you from gaining weight. Then as Teagan was mentioning, there's a lot of different organizations here in Charlottesville that are in the food insecurity space. Then I learned about a group called Cultivate Charlottesville, which amongst many things is also looking at how can we help school lunches. Now I do not want to disparage school meal programs because I really think they really are an excellent safety net. I know the schools do the best they can with the budget that they have with those. They're critical. I don't want to disparage them at all. But I know that they can be improved. This group Cultivate Charlottesville, works in that space. I started meeting with them and then I mentioned what I do and they said, you really should look into this group called Local Food Hub, as Teagan had already mentioned. They have a partnership with a bunch of farms in the area. You can write a prescription for healthy, fresh food for your patients. That's how it all started. I knocked on Teagan door one day and said, hey, I've met some really great people, who are doing some really neat stuff, gosh, we should partner with them. That's how it got started. I love it. I love it because, the one thing we can do in this work is try to keep people out of doctors offices. We can do that by making sure there are some healthier options upfront. I know options and choices or are tough for a lot of people, especially those that are dealing with several kinds of inequities. But the fact that you are connecting the dots for them, you're able to provide them healthier diets, healthier foods. With the idea of lowering risks for not only that patient but the whole family. That's an excellent point because well, Teagan and I are pediatric providers and that's where it starts with, those children are the way to get the other families involved and hopefully to see these healthy choices are great. Now I have a little bit more money to use for something else instead of having to. Healthier options are becoming much more affordable, we used to be active in something called the Nine Minute Meal which is, we'd figured it took about nine minutes to go through drive-through. What can you make in that amount of time? Lots of great things, healthier, less expensive and in a faster time. There are some models out there, we can gamble it. It isn't always easy. I remember speaking to a group of people on this very issue and we were talking about soup kitchen, that was serving organic meals. There's a lot of [inaudible] that thing. There's one woman who said, "We make these choices to sometimes eat at fast-food restaurants because it makes my kids feel normal. This is for the homeless family." I thought, wow, that's what makes them feel normal. I get that on some level, but I didn't even think that was even a possibility. The fact that in my observation, when we see programs like yours and you've normalized the importance of it, and it makes it, not only a healthy choice or healthy option, but it's also a great thing to do. I mean, you're connecting people to farm crops, and you're involving, you're really investing in a culture change here. One day, those experiences at farms are going to feel more normal than the drive-through restaurant. We try to make it as convenient for people as possible. There's so much involved in people's health. Food insecurity is just one part of it but as Teagan said about transportation, food gets delivered directly to them. That way you don't have to miss school, miss work. Is the food always delivered or there are options to pick it up? It's always delivered to homes, is that correct? It is. I think eventually, maybe when our COVID pandemic goes away, we may give the families option to come pick it up. But at least now with difficult transportation, but also not wanting as many people to come to the hospital. No, you don't want to further the risk. Unless you really need to. I got that. What year did you both start doing this? What year was this? As the pandemic was hitting, honestly. The program officially started in the Fall of 2020, but the ideas of it started around March, 2020. I was mentioning earlier about this group called UVA, Charlottesville. They had set up a day during the Spring break in April, 2020 when students are out and they don't have access to their usual school lunches and were handing out lunches. That's where a lot of that idea started and so now our fresh pharmacy program has been in place for a year. Then for about the last six months now we started a clinic-based healthy food pantry that people can access the day that they come in for their routine vaccines or whatever visit they're going to. Wow. Then how is that matter? How do you regulate or manage that one piece when people come in? What does that look like, the pantry? Higgin said this earlier, everybody, for whatever reason you're coming to the clinic gets screened for food insecurity. If you screen, yes, one of our social workers comes to meet with the family or the child and talks about what programs they're eligible for, including the fresh pharmacy program and then they say, do you need food today? If they say, yes, we give a list of some food that Higgin and one of our other partners, Olivia or Patelo, had put together. Non-perishable food items that we believe are low salt, low sugar, oatmeal, that sort of thing, stuff that's healthy for you and then they can take food that day. Then we monitor it. We originally got some grants from Kroger's Foundation and they've been a really great partner for us and we continue to work with them. Then UVA Children's is also contributing to that as well as some other local citizens as well. That actually has been an eye-opening, how many different people have contributed. Well, we know the important work that UVA Children's is doing and I speak for myself. I'm so grateful to have you both doing the work that you're doing, bridging the gap on some of these critical issues, providing food, really, at people's fingertips and when they need it most. There's nothing worse than being in the hospital, being hungry, and then going home not feeling well to an empty kitchen. That's incredible work and it's very much needed. Is there a way that people can support this work? How can they support? I know we're going to put links about your backgrounds and how they can be in touch. But is there a way that they can be part of this and support this work? Yeah. We do fund-raise through UVA's foundation. All that money goes directly to purchasing food. Right. None of these families are charged any money, it's totally free to them. For those who wish to kick in and help out, they can go to the UVA website, to their foundation website. Is there a drop-down or something that they can click on where they can say, okay, we'd like to. If you say UVA Children's Fresh Farmacy and that's a Farmacy with an F. UVA Children's fresh Farmacy. That's good. Hey, you like hearing that. What can we do? What can our audience members do in their own communities to do what you're doing or move the needle in some way so those kids that we suspect of not really having the access they should, how can they help? I would say just recognizing that it is a problem and it's maybe even underestimating how many people have food insecurity. Then also that it's not a personal defect that, oh, you're obese or you are unhealthy because you don't like to eat healthy food. They may not have access to it or may not have been able to afford it. It's a chronic health issue, it's epidemic, it's chronic. Would it be reasonable for people in their communities to reach out to their local hospital to say ask them maybe if they knew a way they could help them bridge that gap, would that be maybe a good step? Absolutely. Local health systems have a lot of experience of taking care of patients and a lot of access to funds. I think they can really do a lot for their local communities. Yes, they can. They have a lot of information, they understand where they're sending people, so you might want to speak to a patient advocate or a social worker at a hospital to see how you might be able to help in your community. That's great. I love what you both are doing. I'm so glad you were here to join us today. I hope we can work together in the future to support you in some way. I appreciate you being here. We understand that when we work to prevent disease and lower risk, it starts at our table. That's where all that starts, it starts at our table. We have an opportunity in many cases to lower that risk and when access isn't available, there are some solutions out there that we're all working on to make happen. Thank you for your important good work. We're so grateful to have you here today. Thank you very much. It was great talking to you. We really, really appreciate it.
