[00:00:00] Speaker A: Foreign.
Hello and welcome to Just a Bite. I'm Eliza Richardson, Programs and Contracts Manager with the Ohio association of Food Banks, and I will be your host today. November is National Diabetes Awareness Month and today we are exploring the connection between food insecurity and diet related chronic diseases such as such as diabetes.
Chronic illness is common among households experiencing food insecurity and often create additional financial and daily living challenges.
The connection between health and food insecurity is complex.
Poor health can contribute to food insecurity, and food insecurity can make health conditions more complicated.
Diabetes affects roughly 38 million Americans, including adults and youth.
According to the 2026 Hunger Study conducted by the Ohio association of food banks, roughly 76% of food bank participants surveyed said someone in their household was living with a health condition and 31% of households surveyed included at least one member with diabetes. Joining me today are Zach Reit, Senior Director of Strategic Initiatives at the Ohio association of Food Banks, and Amy Headings, Director of Research and Nutrition and Registered Dietitian at the Mid Ohio Food Collective. Today we will talk about what it takes for households experiencing food insecurity to manage a chronic condition such as diabetes and the everyday factors that shape health, from income and housing to transportation and access to care. Then we'll look at how food banks and healthcare partners work together to help neighbors manage their diet related chronic conditions through Food as Medicine programs such as Pharmacy Ohio. As always, you can check out our show notes for this episode and all
[email protected] JustABite let's get started.
Hello and welcome to Just a Bite. Zach and Amy, thank you both for being here today. I'd like to give you all an opportunity just to briefly introduce yourself, what you do at your organization and your roles.
[00:02:18] Speaker B: Well, I'm Zach at the Association. I work on health insurance enrollment programs, our national service programs, and then also support our 12 member food banks in pursuing food is Medicine work.
[00:02:31] Speaker A: Awesome.
[00:02:32] Speaker C: Hey yeah, and I'm Amy Headings. I am at Mid Ohio Food Collective and I work on all of our initiatives that involve health care, whether that be healthcare partnerships, healthcare research, acquiring foods that help improve health outcomes. Anything like that really falls under my purview at Mid Ohio.
[00:02:55] Speaker A: Awesome. Happy to have you both here today.
[00:02:57] Speaker C: Thanks.
[00:02:58] Speaker A: So, just to set the stage a little bit, November is National Diabetes Awareness Month. Diabetes is among many chronic health conditions that food insecure households tackle at a significantly higher rate than food secure households. Amy, can you set the stage for our listeners a little bit and talk about how food access can affect Someone living with diabetes and how this has an impact on their health conditions as a whole.
[00:03:23] Speaker C: Sure. Well, one of the things that we understand better now than we did 15 years ago is really the cycle of food insecurity and the development of chronic diseases.
And so if you think about someone who is facing food insecurity, they're really making a lot of choices. Do I have to pay my health care provider, pay for my medication or pay for my housing? Food. Food becomes one of the lower priorities. So at that point in time, someone, if they have a chronic disease, are making choices about the foods they purchase and sometimes will purchase foods that are less healthy for them.
What results is poor chronic disease control. What that results in is a visit to your healthcare provider or the emergency room. In some cases, the healthcare provider oftentimes will prescribe more medication or prescribe a more expensive medication.
And so the person is then left in the lurch of trying to understand, okay, now, am I going to pay for my visit to my health care provider? Am I going to pay for my additional, more expensive medication? Am I going to pay for housing? Am I going to pay for food?
That also really results in more competing demands and will frequently end up someone in a hospital and then you have the emergency room bill to pay for it. So it's this terrible cycle of making choices and having poor health outcomes because of those choices.
[00:04:52] Speaker A: Absolutely.
And one thing that we refer to this commonly as is the social determinants of health, which you very clearly just described. Can you talk a little bit about not only how this affects people living with diabetes, but other chronic diet related diseases as well?
[00:05:11] Speaker C: So there was a paper that was published many years ago that show that social determinants of health or social drivers of health contribute up to 80% of a person's health and well being, versus about 20% being that visit with your doctor or clinical care.
And so if you think about things like the five main things that fall under social drivers of health are economic stability, education, access and quality, healthcare, access and quality, neighborhood and built environment, and social and community context.
Those things really matter. So say, for example, that you have diabetes or cardiovascular disease and you need access to healthy food and you live in Franklin County.
Housing costs are in Franklin county are pretty high. But let's say that someone has stable housing. They also might have access to the bus in order to get to a grocery store or a food pantry. But now let's go to Benton county or someplace else that's further away.
And so someone there may also have diabetes, but the Public transportation system is not well built out in a rural area. And so things like transportation or poor housing or something like this are really going to make an impact on that person's ability to access the foods that they need or even just the healthcare access that they need. So all of these competing things, competing social drivers, really contribute to whether a person has a better health outcome or a poor health outcome.
[00:06:41] Speaker A: Yeah, exactly. How can managing a chronic condition put additional pressure on that household's food budget? And how can that financial pressure make managing the condition harder and force people to turn to our network of emergency food providers?
[00:06:56] Speaker C: People will prioritize housing over anything.
As we see the increase in housing costs, we see people really budgeting out to pay for their housing or pay for their gasoline to get to work. Food is what really gets cut.
And so at that point in time, we see people showing up to our food pantries to acquire food. And, you know, since the pandemic, I would say we've really seen an increase in the number of people that are using the emergency feeding network.
It's not just housing. It may be something, maybe somebody is stably housed, but it could be something else. Their car breaks down, a family member has lost their housing, and their household becomes bigger.
So all of it's compounding and all of that may complicate decisions people are making about paying for medication and other kinds of health expenses.
[00:07:49] Speaker A: Yeah, absolutely. We at the Ohio association of Food Banks recently conducted our 2026 hunger study.
We found that 45% of the households that we surveyed chosen chose between affording their rent or mortgage or affording food. And then we found that 48% of households chose between affording medicine or affording food.
And the highest trade off was transportation, with 63% of households choosing between affording transportation or affording food. So that really puts into perspective exactly what Amy was just talking about and the trade offs that individuals who are accessing our network experience daily.
So, Zach, can you talk a little bit about how Ohio's network of food banks can provide support to individuals who are experiencing these chronic health conditions, such as diabetes, and provide them with the resources that can support their overall health.
[00:08:41] Speaker B: So Ohio food banks are providing support to people seeking to improve their health on a continuum of ways. Right. When we talk in food is medicine circles, we talk a lot about a pyramid, right. Where we have interventions at the base level that have a very broad impact on supporting health for entire populations. And then as we go up the pyramid, we're developing interventions that have an impact on people with more acute conditions.
So at that base level, food banks are first and foremost providing emergency food assistance to people who are dealing with this incredibly complex web of needs that Amy just described. We're also making sure though, that through emergency food networks, there are healthy foods available.
As we move up that pyramid, we're doing more work in direct partnership with healthcare providers where our doctor is maybe talking to us or asking us to fill out a form where we talk about our access to food. And if we're identifying people who are food insecure and then making connections to the food pantries or to specific programs that we've developed like Pharmacy Ohio, which we're going to talk a little bit about, like some medically tailored grocery programs like the Nourishing Beginnings program in Greater Cleveland, there's a, there's a program specifically for people with kidney problems. Out in West Ohio Food bank, we've got some really neat medically tailored programs that are being developed. And then as we get to the very top of that pyramid, we're providing support through programs like Medically Tailored Meals.
And those are things where we're looking at the diet needs of people with very specific conditions and for people who maybe have trouble preparing their own meals and actually providing those meals to them. So it's services that exist along that spectrum, really trying to meet the patient where they're at and provide the services that they need.
[00:10:57] Speaker A: That's awesome.
And so for any of our listeners who are just hearing about these Food is Medicine programs for the first time, specifically Pharmacy Ohio, which is a program that we are working to expand across the state of Ohio so that people all around the state of Ohio, no matter what county you live in, can access these Food is Medicine services.
Can you walk us through what Pharmacy Ohio is, which food banks are currently operating this program around the state and how it helps neighbors to treat their diet related chronic conditions?
[00:11:27] Speaker B: Yeah. So at its core, Pharmacy Ohio is a program that connects healthcare providers, their patients and food banks. And it gives patients weekly access to produce at no cost.
And then it sends data back to healthcare providers that enables those healthcare providers to provide better service.
Program was built by the superstar sitting next to me, Amy Headings over years of dedicated work with healthcare providers in central Ohio in the mid Ohio Food Collective service area.
And then with support, we recently expanded that to two other food banks.
So it's currently active in the service area of Greater Cleveland Food bank and also down in Hocking and Athens counties, which is in the service area of our Southeast Ohio Food Bank.
The way that it works is a healthcare provider screens for food insecurity, usually using a two question screener called the hunger vital sign.
And then if they identify a person who's food insecure and maybe a person who also has one of the chronic diet related conditions Amy's been talking about, they will make a referral to the Pharmacy Ohio program.
When an individual accepts that referral, we create a essentially household record for them in our data system and attach that record to a customer ID and give them a card. Just like, you know, you might get a Kroger card or a Sheets card, right.
It's got a barcode on it. And the patient can then take that card to a network of Pharmacy Ohio pantries. And those are emergency food pantries that have really made a commitment to providing access to produce to individuals and allowing people to come at least once a week to pick up food for their household.
And then when those services are tracked in our data system, we're able to then send that back to the healthcare provider. So at that next checkup, we're not having a conversation about whether there's food insecurity. We're starting from a place of understanding that there was food insecurity. And then we can start talking about how this intervention has helped deal with that problem of food insecurity and then maybe had an impact on our health outcomes as well.
[00:13:57] Speaker A: That's amazing. Amy, can you talk to us a little bit about how Pharmacy Ohio specifically looks at the Mid Ohio Food Collective? How many people are you regularly serving and what types of healthcare partners are supporting this program within your service territory?
[00:14:11] Speaker C: Yeah, as Zach said, we've been doing this program since 2015, I think, so over 10 years.
And it's taken a lot of dedication to understand how we can best link the systems that currently exist for the better health of the patient. And so at Mid Ohio, we work specifically to identify food pantries that have high capacity and are distributing produce on a regular basis.
Essentially this program exists as a produce prescription program, not only for the patient, but when a patient visits, we know that if they are insecure that the likelihood their household is also struggling with food is pretty high.
We have the opportunity for them to enroll in some nutrition education and other health related tips over our texting program.
And it's really at the volition of the patient if they want to enroll in that type of thing.
And so we see on average over the last couple of years, 3,500 people new per year enroll.
And the type of healthcare providers that are referring people are managed Care organizations that are Medicaid insurers, to large healthcare organizations located here in Franklin county, to federally qualified health centers. And then there are multiple free clinics that we also partner with. I think the great thing about this program program is that it's very accessible. It doesn't really matter if you're a managed care organization or if you're a free clinic. We want to be able to fit into that schema of where your healthcare is right for you and how can we make that food access right for you too.
[00:15:59] Speaker A: That's amazing. And I'd be really interested to know how your team at the Mid Ohio Food Collective adapts to barriers that may still exist in households that are accessing the Pharmacy Ohio program. So issues like transportation or pantry hours, language access, or access to refrigeration at the pantry level, how does this affect participation in the program? And how does the Mid Ohio Food Collective make sure that Pharmacy Ohio is accessible to as many neighbors as possible?
[00:16:30] Speaker C: Part of my favorite thing about the program is we have patients that just call the food bank. And from those calls that I understand really a little bit better what that patient is facing.
For example, one person called and not only did they need the produce, but they also needed access to snap. And so I think that's the great thing about food banks is that we have people like, not only working on fresh food access, but we also have other teams that are helping people connect in other ways. I also talked to another patient and, and we were able to drill down that transportation was her real need. So a lot of that happens really on a case to case basis. Through our texting program, we're also able to communicate with people that way.
We have the most amazing network of dedicated food pantries that they have doubled down and they step up to the plate every day. When people come in with a Pharmacy Ohio cart, if somebody doesn't know the language, they, they figure out how to get an interpreter on their phone. If they haven't seen someone for a while, they're like, oh, hey, we haven't seen you in a while. What's been going on?
I cannot even really reiterate how important our food pantry partners in this are. They are the boots on the ground. They are the face of the program and their value. I cannot even say how valuable they are in this program.
[00:17:55] Speaker A: That's incredible.
So as you just talked about, accessing food for someone who is experiencing hunger and food insecurity is a great portion of the work, but it's also step one and step two is ensuring that the food that we are able to provide that person fits their health needs and the needs of their households and the daily routines that they have throughout their lives.
Can you talk to us a little bit about what kind of food is available through Pharmacy Ohio and how this food specifically supports the health of someone living with a chronic health condition like diabetes, and how that might differ for someone living with type 1 diabetes versus type 2 or another chronic related health diet related chronic health condition such as high blood pressure, heart disease, etc.
[00:18:41] Speaker C: Thanks for that question, Eliza. So the first thing that I want to say before really talking about the type of food is that connecting with a registered dietitian or someone through your health team that can help you create a plan that's specific for your needs is super important. First off, I just want to say that.
And then once you have that plan, that's kind of where we come in.
One of the things that we do through Pharmacy Ohio is it is a produce prescription program. And if you look across chronic diseases, cardiovascular disease, diabetes, hypertension, cancer prevention, produce access is core to that. And so that's really what we're enabling through the Pharmacy Ohio program. However, when someone visits a food pantry, there are also a lot of other foods there that can support health. And so I just want to give a shout out to those foods as well, because we know that storage is an issue for some people. Canned foods and frozen foods are also equally as important in someone's diet because every food plays a role. It's not just the fresh produce.
[00:19:48] Speaker B: I just want to jump in here and say we did a process evaluation of Mid Ohio's pharmacy program before we expanded it to the other food banks. And one of the key findings from that evaluation was that people generally knew the types of foods that they needed to be eating. They had accurate health knowledge and nutrition knowledge.
But access and cost were primary barriers to following through on that knowledge. And I think that showing up in an evaluation of a program that you're about to expand around the state is really encouraging because like Amy said, that's what we're doing, right? We're reducing those barriers to accessing the foods that people know that they need but have struggled to bring into their household.
[00:20:38] Speaker A: Yeah, that's incredible. Thank you so much for pointing that out. So, Zach, since you just mentioned the process evaluation that you went through in order to expand Pharmacy Ohio to other food banks across the state, can you talk about what outcomes we're seeing regarding neighbors who are accessing Pharmacy Ohio and what outcomes we're seeing? Related to their food access or their health outcomes as a result of participating in this program.
[00:21:03] Speaker B: Absolutely. Mid Ohio recently published a policy brief about some research that they had done. And one of the key findings from that was that the program helped to stabilize the health outcomes of people who were enrolled, and particularly for people with lots of comorbidities. Right. Which means they have a lot of different chronic conditions going on.
And for people who visited the pantries often, we saw some pretty important reductions in key metrics of body mass index and hemoglobin A1c, which is essentially an average of your blood sugar levels over time.
Those were really important outcomes that we can connect to healthcare savings.
This Mid Ohio policy brief talked about some numbers in terms of healthcare savings, and they're consistent with what we're seeing from national research that shows when we invest in interventions like Pharmacy Ohio, like Nourishing Beginnings, like the other programs that are being done at food banks, we see some cost savings. And frankly, more important than that, we see people's food security improving in their households. Right. And like, if we can reduce stress in households by making sure that people have access to foods and foods that really support their health, I think it's a worthwhile investment.
And that's what the outcomes evaluations are showing us as well.
[00:22:41] Speaker A: Absolutely.
So I'd be interested to know from the both of you, where are the biggest gaps to accessing a food as medicine program like Pharmacy Ohio, and what can healthcare partners or other community organizations do to support the success and growth of programs like this?
[00:22:59] Speaker C: One of the biggest gaps that exists today still is screening people for food insecurity. You have to, before any dietitian can make a recommendation for a diet, some kind of medical nutrition therapy, the person has to have access to the food in order to make those changes. And so really identifying, learning about how to have that hard conversation sometimes, and how do you make it less weird for your patient to say, hey, do you have access to food? So that's step one, but step two is figuring out in your community, where are the food access points? Because sometimes, you know, you may not live in the community where you practice.
And so being very familiar with what the points of access are for food, going over, taking a tour, seeing it with your own eyes, to see what kind of foods are provided is very important.
[00:23:55] Speaker A: Love that.
[00:23:56] Speaker B: I'm just going to come back to that. Process, evaluation, finding, you know, people know what they need to eat. And a lot of times people aren't eating those foods because they're really expensive.
Right. So Like, I hate to bring everything back to money and a need for funding, but that's where we're at, right? Yeah. If we can get the screening there, we can get providers familiar with the resources that are available in their communities. We need funding which requires policy to really scale these programs across the entire state of Ohio, make them equitably available in communities across Ohio, rural, urban, in food deserts. And we just really need to connect that individual doctor patient relationship with the public policy and funding support in order to really scale not only the availability of the programs, but the potential impact of the programs.
[00:24:57] Speaker A: Absolutely. And for someone who thinks a program like Pharmacy Ohio or any other Food is Medicine program might be suitable for suitable for them, where is the best first step that someone can take?
And if they are maybe not visiting a participating provider, where can they access food assistance today to begin that journey to accessing these programs?
[00:25:20] Speaker B: Yeah. So there's more information about the Pharmacy Ohio program specifically on pharmacyohio.org and you certainly can ask your health care provider about the Pharmacist Pharmacy Ohio program. If they're not a referring provider, you can share with your healthcare provider. Hey, I'm having trouble accessing food and I want to improve my health by, you know, making the diet changes that you're talking to me about. But access is a major barrier for me. Can you point me to some resources?
You can also Visit our website, OhioFoodbanks.org where you can find find your local food bank. We have links on our website to all of the food locators that are food banks around all 88 counties in the state.
Access.
Here in Central Ohio, it's freshtrack.com where you can go and type in your zip code and learn where the emergency food resources are in your community.
[00:26:19] Speaker A: Awesome.
[00:26:19] Speaker C: I would just say that if you've never been to a food pantry before and there's like maybe a little bit of fear, the people that work at food pantries are awesome and they can definitely help you figure out what the process is, figure out what you need in order to get food there.
I just want to encourage people that, you know, if you feel fear about going, go, go. There's people that can help you.
[00:26:44] Speaker A: Yeah, I love that. Zach and Amy, thank you so much for joining us in this episode of Just a Bite and for sharing your expertise on this really important topic.
If you're interested in learning more about Pharmacy Ohio, visit Pharmacy Ohio.org to explore participating locations and information about getting connected to your with your healthcare provider. If you are in need of food assistance, please visit ohiofoodbanks.org and click find your Food bank in the top right hand corner. Or visit the links in our Show Notes for resources mentioned in today's episode. Visit Ohio Food Bank's and check the Show Notes for additional information.
If you enjoyed today's conversation, please subscribe to the podcast and share the show with your network. Until next time, take care.
