Editor's note: This story is part of a series addressing the issue of food insecurity in Richland County. The series will continue throughout 2017 and feature interviews with those working to mitigate the problem and the obstacles they encounter.
MANSFIELD -- It would be inane to separate food from health.
The two go hand-in-hand: the poorer the diet, the poorer the health.
For those who lack the means to stock their refrigerators and pantries with nutritious items, the risk of health-related issues increases.
According to Feeding America's Hunger in America 2014 survey, many households served by the Feeding America network of food banks include people coping with a chronic disease that is impacted by dietary intake.
"Fifty-eight percent of households have at least one member with high blood pressure and 33 percent have at least one member with diabetes," the survey states.
For those who suffer from food insecurity (the state of being without reliable access to a sufficient quantity of affordable, nutritious food), a possible solution to support their health is a food pharmacy program.
National Public Radio reported in May about a new food pharmacy located on the grounds of a hospital in central Pennsylvania. Participants meet with a registered dietitian and are given recipes and instruction on how to prepare healthy meals. They are provided with "a very different kind of prescription," that being five days' worth of free, fresh food.
This isn't the first of its kind. In fact, ProMedica Toledo Hospital has a food prescription program, allowing any ProMedica patient (with a physician referral) access to either two of ProMedica's food pharmacy locations. The program launched in April 2015.
"It's meant to provide and create access to healthy food options for our patients and a way to improve their health," said dietitian Chloe Plummer.
The process works similar to a prescription for medicine.
"Their doctor will write them a referral and give us some information about the patient's medical background," Plummer said.
The pharmacy is set up like a choice food pantry, serving healthy food options. Nutrition professionals are available to provide assistance in selecting items best suited to the patient's needs.
"They (patients) are eligible to sign up for nutrition counseling with a dietitian, and we also offer healthy nutrition handouts and recipe cards," Plummer said. "We're trying to educate the patients about making healthy choices in addition to providing healthy food."
Patients may receive two to three days worth of food per visit and are eligible to return once per month for up to six months, at which time they can return to their physician for another referral if they are still in need.
Both of the food pharmacies are housed in outpatient buildings. The second location was added in January 2016.
On average, the program serves a little over 800 people per month, according to Plummer. Patients are not required to meet specific income requirements, but are screened using a two-question tool known as the "Hunger Vital Sign," which is meant to identify a broad population of individuals in need of healthy food.
The program can aid those already suffering from conditions such as diabetes or high blood pressure, while also serving as a preventative health measure to those who don't have existing chronic diseases.
Patients have reported a reduction in stress, an increased ability to make healthier food choices while feeding their respective families, an uptick in fruit and vegetable consumption, and an overall better understanding of nutrition in their lives, Plummer said.
When it comes to establishing a program such as this, Plummer said it requires space with shelving to store the food, relationships with local physicians and providers that could refer patients, and relationships with local food banks and other food resources to help stock the pharmacy.
Much of the food in ProMedica's food pharmacy is sourced from a local food bank in Toledo (SeaGate Food Bank), with a portion of food purchased from local produce vendors, Plummer said.
"We started as a very small program and we're growing rapidly while trying to adapt and change as we grow," Plummer said.
According to Feeding America's Map the Meal Gap project, 77,690 people were considered food insecure in Lucas County (Toledo) in 2015, with a food insecurity rate of 17.8 percent.
In comparison, Richland County was estimated to have a 15.8 percent food insecurity rate, with 19,290 people considered food insecure that same year.
Emphasis on health
Food is often "low on the totem pole" when it comes to prioritizing expenses on a fixed income.
"When we have a limited budget, food is the last thing that we want to spend money on," said Irene Hatsu, assistant professor and state specialist with The Ohio State University. "There are immediate consequences to not paying your rent -- you become homeless. There are immediate consequences to not being able to afford medication."
Not only that, but if a low-income household wants to eat the way the USDA recommends, they're going to spend anywhere between 43 percent to 70 percent of their income on fruits and vegetables, Hatsu said.
So how do people cope?
Note that 79 percent of people report purchasing inexpensive, unhealthy food as a coping mechanism to food insecurity -- which doesn't come without consequences; namely, obesity-related chronic diseases. This creates a vicious cycle, causing more money to be taken away from food to be able to pay for healthcare bills.
"The truth is, if we can provide people with healthy food, not just food but food that is healthy, No. 1 it would help with their disease, No. 2 it would decrease healthcare utilization cost, not just for them but the whole community," Hatsu said.
Look at the estimated cost of a visit to the emergency room for someone with hypoglycemia versus the cost of monthly groceries for a family of four.
It's a no-brainer which one you'd rather have to pay.
Hatsu recommends early intervention to help those suffering from food insecurity in an effort to prevent coping mechanisms that could lead to chronic diseases.
"Instead of waiting until someone has a complication or a disease, why don't we intervene right at the beginning when they are showing signs of food insecurity than wait until they develop the disease and then throw healthy food at them," she asked.
In order to help identify food insecure individuals and connect them with valuable resources, Hatsu suggested that food pantries or local clinics utilize the two-question food insecurity screening tool, also referred to as the Hunger Vital Sign.
1. "We worried whether our food would run out before we got money to buy more." Was that often true, sometimes true or never true for your household in the last 12 months?
2. "The food that we bought just didn't last, and we didn't have money to get more." Was that often, sometimes or never true for your household in the last 12 months?
"These are two questions that can easily be incorporated into intake forms at food pantries or at clinics and would help us to identify an individual who is food insecure so we can intervene at the beginning rather than wait until they have a chronic disease," Hatsu said.