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um so first off we've got some learning objectives today this is a cme event uh for those of you that want to receive credit for that so today we'll define food insecurity and who's most affected by it we'll identify some and note the asterisk some resources that create uh community level nutrition security for individuals and families this is a tip of the iceberg just a taste today along with the nutrition theme and that's not to underestimate all the great work that's not highlighted today and then thirdly understanding elements um an evolving community vision in which everyone in dane county eats healthy so uh first off i invited michelle and maggie because these things do happen only in collaboration and i've been involved in the emergency food system for about 15 years and there's just so much i don't know and every day i continue to learn how much i don't know and so learning from colleagues like them has been really very helpful um but i'm not alone as a health care provider there's several things we need to learn together sarah downer and her colleagues recently suggest that clinicians get more and better education to integrate food as medicine interventions as you can see here and they also suggest we identify sustainable funding streams to ensure equitable access to this work and availability of those interventions to everybody in our communities so i'll cover a little bit of both today let's get started with some definitions um my setup's a little strange here so i'm sorry that i'll be looking at two screens periodically but food insecurities a household level economic and social condition of limited or uncertain access to adequate food whereas hunger is an individual level physiologic condition that we experience often in our patients in healthcare nutrition security on the other hand you'll hear me refer to that i want you to become familiar with that that exists when an individual at all times has physical social and economic access to sufficient safe and nutritious food that meets their dietary needs in food preferences notice food preferences that'll be a theme today uh to create an active and healthy life and then food sovereignty a little bit of an aside here but that's the right of people to healthy and culturally appropriate food produced through ecologically sound and sustainable methods their right to define their own food and agricultural systems so we'll talk a little bit more about that today so i invited michelle and meg to join me today since the three of us recognized just how important community collaboration is to support the emergency food system some of you have seen me use this before but it's a public health model to help clarify our unique roles in four domains first know what about health second identify where there are individual populations as you can see here at the greatest risk and then third in the top right there will emphasize that today collaboration with others the who to create this collective vision and maximize efforts and fourth how we implement interventions or initiatives that work across really across all of these four action areas for the greatest impact on the health and well-being for all in our community so let's first though start by looking at where are the populations then at greatest risk so millions of seniors people with chronic illness and communities of color are newly experiencing food insecurity and you'll hear from michelle and maggie later on that but this is really because the economic recession from the pandemic and if you're not familiar feeding america's map the meal gap is an annual report we've got 20 20 data here that we're looking at and on the left we've got insecurity rates for the overall population and then on the right we've got kids um as you can see up in north dakota a low at six percent is down in jefferson county mississippi there's a seven percent food insecurity rate for the overall population kids there are several states one out of three kids are food insecure um let's take a look a little closer here in wisconsin so this is 2018 map the meal gap which is our most recent and at that time three years ago we had five hundred thousand half a million food insecure people just in our own state alone considering the average meal cost in wisconsin at that time was 2.84 cents we ultimately had a gap of 250 million dollars from a food budget to be able to match what was needed for those 500 000 food insecure people i want you to pay attention to that meal cost we're going to reference that several times today 2.84 cents in 2018. then let's take a little closer look here at team county um we had about 40 000 people in dane county in 2018 who are food insecure and then accounting for our higher cost of living in the average dane county meal cost in 2018 to 3.29 we had a 22 million dollar gap to meet those needs of those hungry people and it's worse definitely in 2021. it's estimated now ballpark and michelle might have greater data on this later but we now have about 60 000 people in dane county uh experiencing food insecurity with about one in five kids locally living in poverty here you might not have seen this before but these are dane county opportunity zones so uh where are the opportunities um really opportunity zones are economically distressed communities defined by census tract and there's 8 700 of these in the country and really they've experienced a lot of uh or minimal investment i guess over decades really and this gives you a sense where they are here in dane county several in the south and north sides of madison and sun prairie and then i do want you to note on the right side there that some of these low income zones the range of median household income in those homes is 7 500 to 28 dollars that's not a lot of you know food money and housing money and transportation money um that's what we're dealing with here locally um we refer to these then more locally as food access improvement areas i've inserted three of our four don't dane county family medicine residency clinics i'm in one of them right now at the verona clinic you can see where they are here um verona southwest wing road near the isthmus and up on the northeast side of northeast family medicine clinic um in our uw health hospitals and clinic we use these two questions to screen our patients for food insecurity uh within the first i'm sorry within the past 12 months we worried whether our food would run out before we got money to buy more and then second within the past 12 months of food we bought didn't last and we didn't have money to get more um if a patient responds often true or sometimes to either question they are considered food insecure and although we know it's the right thing to do turns out this screening can add to our health care provider burnout crisis if we don't actually have the knowledge and the capacity to know what to do when somebody uh screens positive so hopefully after today you have more confidence to respond when that is the case so high unemployment has actually led to the median income in several dane county households of 30 to 40 thousand dollars and over 50 percent of our students in the madison metro school district qualify for free and reduced meals which should give you some sense for just how important those meal programs are for so many of our kids um it was great to see schools use their established bus system and shift to neighborhood delivery of school meals over the past years and mechanism to continue to provide this important nutrition even when schools were closed i keep this close by this is the zzz's applesauce that my kids get from middleton and it's from michigan and you all hear me talk about why not using wisconsin apples you know here for our school kids um so what do these kids do actually then when school's not in session um you know on weekends they have a food for thought weekend food bag program you might be familiar with and thanks bill schwab you pointed that out earlier to several people this last year provides a bag of two nutritious meals healthy snacks beverages uh each friday during the school year for those kids to eat over the weekend and then summer meal programs are equally important they're offered in several locations in our area and provide up to two free meals monday through friday with choices of breakfast lunch or snack and related to healthy nutrition and kids if you haven't seen it yet the newest nhanes data just came out notice these are always like delayed so this is the 2718 survey data and it's one in five kids are obese and those highest affected are among the black and hispanic youth so certainly our school nutrition programs and summer meal programs are helpful tools to possibly reverse these trends so i hope this slide overwhelms you that's the intention here but what do you do when someone screens positive it's as simple as weaving together grocery stores farms distributors community centers food pantries policy and more right then you can just turn this simple diagram into a dot phrasing epic put it in your visit summary and boom you're done right maybe not that simple so i've committed to learning a lot about this um and thanks to some collaboration with the healthy kids collaborative julie stanley um shelby jen shelly shaw and others i'm missing several i'm sure but we put this together several years ago and to say the dane county local food system is complex i think is an understatement of the day so let's navigate the complexity the first thing you should be familiar with is united way's 2-1-1 resource so it's a tool to connect individuals and families to not only food resources in the community but to financial support food resources housing addiction treatment health care mental health care heating utilities assistance you can see the list there um so in addition to the two on one like telephone line you can also search online by zip code with your patient to look for some of these things with them in your office setting so in addition to two on one we're blessed here at uw to have a really great patient resources team navigators in our clinics and community health workers can also help thanks jonas to you and your colleagues for making these connections in our community and they can connect to community meal sites food resources grocery assistance et cetera transition to a few more definitions so what do people actually do um to get coverage they use snap a supplemental nutrition assistance program it's federal food stamps is a swear word so no longer use that i've exited out here for that purpose this is the like federal food stamps program um in wisconsin we call it food share as you can see here and then the mechanism with which you spend your food share dollars that's through a quest card which is actually a plastic debit card to access food share benefits and you can use these in stores and farm markets and actually some meal sites and then note in the bottom left there where you can't use these in certain circumstances alcohol uh included so um let's talk a little bit about um some of the steps that we've actually taken to increase these food share dollars and other benefits during the pandemic the federal coveted stimulus package sent in a lot the end of december 2020 included funds um to increase the maximum allotments for food share recipients by 15 for six months january through june 2021 uh who knows what the new administration will be and what extension of these things there might be but uh just to give you a sense now i'm gonna do a little math you all know that i do math when we do presentations together but to be able to grasp this i wanted to talk about a family of four in dane county um so uh the the cost per individual meal now here in 2021 is estimated to be three dollars and 55 cents per meal so let's do some quick math for this family of four um just two good meals per day adds up to eight hundred and sixty three dollars a month and even with this expanded food share benefit that was recently increased by fifteen percent that leads up to seven hundred and eighty two dollars there's a mismatch and again that's just for two good meals per day keep in mind though with that said um you know many of these families do have nutrition support from their schools and then hot off the presses just this week is the cdc data brief on the right that i've included there also enhanes data that shows fruit and vegetable consumption by income level and it might not be a surprise to most of you but lower income levels correlate with a significant decrease in both fruits and vegetables across the board so wisconsin is one of several sites piloting online purchasing um with these snap dollars because the pandemic and so the retailers included include aldi amazon and walmart associated delivery charges are not covered by the snap dollars and thankfully we have in madison as many of you know many local delivery options from grocery stores restaurants and others but several communities in the country do not have those delivery options to have here i know about you but i have never looked more forward this time of the year to brighter days and usual summer fun i'm i'm definitely looking forward to a return of the dane county farmers market to the capitol square sometime soon the discover wisconsin farmers market guide is a helpful resource for food insecure individuals to navigate farmers markets and it's available in spanish and as well there are a few pages as you can see i've highlighted some sections from it that specifically describe how food share funds can be used at markets to buy produce direct from participating vendors so you can literally take your food share dollars and buy from vendors at markets directly and related is the double dollars program a dollar for dollar food share match up to 25 dollars per market day at participating farmers markets and the extra money spent by the shoppers goes straight into the pockets the vendors who get reimbursed the full value of every double dollar redeemed and similarly the senior farmers market nutrition program here that i show that facilitates purchases of farm market produce for those uh low-income individuals 60 and older and as you can see that list is a long list of locally grown foods so that's that's great news great access some of you may have heard through the wisconsin partnership program that we're blessed to have access to here at uw a collaboration for farms to families a partnership between reap food group roots for change and rooted it provides home delivery of what we refer to as a resilience box of fresh nutritious locally grown food to serve madison area latinx and indigenous families typically roots for changes doing the screening and identifying the families excuse me and then reit makes the connections to the locally grown food and in partnership with rooted the badger rock neighborhood center serves as the host site for aggregating food and packing the boxes as you can see there um this is also important sticking with the theme of access to fresh produce um joining this dsa actually may not be that out of reach for low-income individuals so the cost of a share just from fair share as an example fair share csa coalition is like 600 and so through their partner shares program um up to 75 percent assistance or 350 is actually available for those in need um and susan veld here and colleagues many of you know wengen tan he's out in penn state now and and susan is out there as well she and her colleagues have summarized the six flavors of healthcare organization based interventions to improve access to fruits and vegetables including cash back rebates like a show here health insurance rebates fruit and vegetable vouchers garden-based programs subsidized food boxes home delivered meals and i think the the six if i remember right is um like collaborative programs between food pantries and clinics themselves so we'll touch on a few of these yet today the wisconsin harvest of the month program our wisconsin school garden network and growing together wisconsin are just a few of several great examples that we have educational programs that lead to increased consumption of healthy fruits and vegetables primarily through exposure and hands-on experien es so we're very lucky to have such a robust educational network here in wisconsin that could even provide guidance as you can see here on how outdoor garden based education could occur safely during covet 19. so transitioning from the field to the kitchen several verona clinic colleagues and i teach about the importance of eating those fruits and vegetables in our chop chop family cooking club melissa referred to the badger prairie kitchen earlier as a beautiful place that we host these on this particular day we were making beet slaw tacos and despite what you might think the kids actually loved them and to facilitate taking the skills home we occasionally give out blenders and other kitchen utensils and basics to those in need the prairie kitchen cooking club you can see melissa there on one of the days provides nutrition education and social engagement for seniors and with that i'll transition now to michelle and maggie to actually talk about second harvest as well as badger prairie needs network in their kitchen so with that michelle thank you brian um and thanks for having having us here today um so what do people do when the money runs out how do people access nutritious food and produce when their food share benefits run out they turn to food pantries of which there are four basic types there are standalone food pantries standalone personal essential pantries mixed food and personal essential pantries and mobile and pop-up pantries that often distribute a mix of food and personal centralized and what is a food bank um i like to describe a food bank as in a couple of different ways one is as a matchmaker or a clearinghouse of multiple sources of food from nationally sourced truckloads to locally rescued retail items which need to be inspected sorted repackaged and connected to other non-profits or programs that help people experiencing food insecurity we spend our time and energy on sourcing storing and distribution so that our partner agencies can spend their resources on direct services which aren't always just distributing food they have a lot of other services to help people with basic needs and self-sufficiency i also think of us as a kind of a big gear in the overall food system we're a food supply gear that helps turn all the other vital gears that help people with food insecurity housing health care education employment transportation and so much more um uh as a food bank you know sometimes people think of us just a scale and for scale purposes uh from beginning if you look at um during the pandemic from march 15th to of 2020 to uh january 2nd 2021 we distributed almost 16 million pounds of food so that can give you a kind of a scale idea of of what we do um but we're kind of the supplier type of of idea here um you know 40 more people are struggling with hunger since the pandemic began and since then food banks have faced a perfect storm that includes surges in demand uh declines in food distribute donations due to supply chain challenges fewer available volunteers and other disruptions to the charitable food systems operating model so how have pantries changed during cobit 19 several changes have occurred during the pandemic in the pantry community several positives include expanded service area boundaries increased visits allowed and some pantries are now delivering and then there are some challenges uh there are some pantries that have more limited hours or have closed all together there's a less of an ability to receive food donations pantry guests are not allowed inside the shop and many have had to transition to drive through and so there's less choice uh you know a pantry we've as a as a network across the country um food pan food pantries and food banks have really moved towards this choice model where we've allowed where we've encouraged uh our participants to be able to select the items that they want and now when people can't come into those pantries to to do that the same way and we've had to do a lot of pre-packing due to to no contact distributions in many ways that choice has been limited pop-up food pantries you know uw's health uw health's pop-up pantry serves employees in needs in need the drive-through is located at the children's hospital entrance and both fresh and non-perishable items are distributed in pre-packaged boxes collaboration partners who provide the food include second harvest madison area food pantry gardens and others unfortunately with weather like we've had this past week the extended hands pop-up pantry and others can't function so now i'm going to turn it over to maggie who's going to share some more about about the work that they do um yeah hi so my name is maggie gleason um i'm the executive director at a food pantry in verona called badger prairie needs network um and yeah like michelle said uh over the last year we have just came a huge increase in demand so um just a quick snapshot of our year last year we did in fact distribute over 95 or 995 000 pounds of food to over 6 800 households and that included 24 600 individuals that were served um and that's up quite a bit um one of the one of the things that we saw that was really surprising was a 500 increase in new households um you know michelle mentioned that we did drop our service area so we now serve all of dane county um and so because of that we saw a lot a huge influx of new households um one of the positive that i'd like to point out from the shutdown and the whole pandemic situation was the ability for the kind of the bigger food pantries in the area to kind of have a little more collaborative effort in terms of coming together and sharing ideas which is something that we hadn't really done before and so we kind of all decided that we wanted to drop our service areas and we are in more um constant communication and partnership to exchange ideas and kind of bounce ideas off of each other and and come up with better ways to serve the community um we another positive that came out of the pandemic for us as we were able to secure some funding um to add on some cooler and free freezer space so we were able to increase our capacity to serve our community not just directly in verona but also to other small small food pantries in the like the rural areas of dane county by being able to um store more cooler and freezer items for them they don't always have enough um capacity to sort that kind of stuff so we are able to collaborate with them and they come and pick up from us at times and we also um built on like a giant it looks like a gas station a little bit but it's a big canopy to help protect our guests um in the drive-through line and also our volunteers which has been uh really great especially in this cold weather we added on like a little outdoor vestibule so when the wind chills are negative 15 we're not we're still able to function and and serve our guests which is great um so uh we also not only are we a food pantry but we also have a couple other different programs that we run out of our building one of them is the kitchen to table wisconsin food recovery network um and that program was started i think in 2019 um with the idea that there is so much surplus food in the area that we um wanted to find a way to collaborate with some of the bigger companies in town epic is one of our big partners and pro-magnet and fitchburg has started to cook for us as well where they um you know epic has a lot of cafeterias i think like three or four really big ones and so they they serve their um their employees but then they have a surplus of food and they would save that food for us and we would go and get it we would pick it up on fridays bring it back to our kitchen and repackage it and then and then we were able to um we were able to distribute that not just to our guests in verona at our food pantry but we share it with um other food pantries in the area small and big so we send we send prepared food over to the river pretty regularly and to saint vincent's um a couple times a week as well and so uh with that refrigerated van that's on i guess it's on my left hand side we we partnered we were able to get a grant a middle mile grant from the walmart foundation in partnership with second harvest and um that van allows us to safely transport the food back to our place so that we can re-uh package it and send it out to other food pantries um in 2020 we were able to provide 160 000 grab-and-go meals through partnerships with epic promega and exact sciences um and so not only does that that partners those partnerships really help us feed uh feed our guests and other other not just our guests but like the whole community and also help us reduce food waste which is uh i think a critical part of the food system too yeah so uh but i don't i joe mingle is someone that is also a someone that rescues food brian can you talk more about him or michelle do you know do you work with joe so yeah joe i mean i i refer to joe as a warrior on the north side um who has been in the food recovery space for a long long time has just done a lot of great work uh but with no big conventions at the monona terrace etc um there's just not a lot of pre-prepared food out there outside of what maggie just talked about and so he's shifted a lot of his work to a more direct uh to door uh delivery uh for the food that he does have and then he's been critical in developing several neighborhood based pop-up pantries that are in these already existing social networks that are so critical uh during the time of the pandemic um just on that last slide i wanted to give a shout out to uw health uh the other refrigerated man in that picture is actually um i think cac community action coalition uses that van to to move some food around and took quite a bit quite a bit of work to get that thing donated but that is a beautiful tool also to have in this network of food rescue um let's see so sorry about that back and forth here so in addition to uh the healthy food for all model that we just talked about there a second ago home delivered meals are most commonly supplied to older adults is part of dane county's senior nutrition program there's actually about 29 or 30 neighborhood sites but most haven't been able to serve due to cobit as you can imagine but when open transportation is available to these sites for those who aren't homebound and to those of you healthcare providers that's a term that we frequently think about is somebody or is somebody not homebound to qualify for certain services it's important to also just recognize that these meals are nutritious but they provide in and of themselves for a day a third of the recommended daily intake for older adults so there's still a gap and they do include protein vegetables fruits grains milks and the payment basis is on a donation basis so where do home delivered meals on wheels come from uh here in dane county and i apologize for those of you up in the cross and milwaukee and wausau and elsewhere i don't know a lot of details about you guys but thanks for letting us talk a little bit about dayton county here today um here from ssm health at home is where the daytime delivered meals come monday through friday and the vegetarian or soft consistencies are available for those that need those i'm circling several prices as we go here the cost for these is about nine dollars and again funding for these low-income individuals is available from services such as dane county human services ssm health at home foundation community donors and others um evenings parkward at home does a similar service monday through friday similar costs at 8 40 to 9 10 ballpark per meal and tonight lasagna roasted zucchini sauteed spinach fresh fruit including a banana looks pretty good i'm proud of this but i'm not proud the fact that healthcare providers are burning out many of us don't sleep well we don't exercise enough and and honestly many of us don't eat well so my approach to um improve staff and physician well-being was to develop a meal kit program for employees in collaboration with mad city chefs care hair nutrition you can think about hello fresh purple carrot blue apron but here in our backyard my family pays about eight to nine dollars per serving for these once weekly farm fresh meals and they're conveniently dropped at the verona clinic so i don't have to chase around as some of you know i've got a two physician household three little girls a daughter with a disability can barely keep it together most days and we're lucky if we don't eat lucky charms i'm ashamed to admit that today but i did it publicly i guess um but not only are we buying local in these meals we're also lifting up uh bedroom prairie needs network because we prep these meals in their kitchen we rent that space um and you know maybe hunger care coalition can help us bridge this gap where at some point we give those patients and staff in our clinics the same things that our pantry folks get and vice versa wouldn't that be a great thing um so not only has it been my dream to have pantry gas and us eating the same things but now i've got several patients eating what i eat it's honestly transformed how i address nutrition in clinic visits for sure since patients thankfully have started to inquire more about healthy food and in meal kits and less about weight loss medications so similar other diabetes prevention programs what this is referring to is verona clinic's fitness and lifestyle challenge you can see the website there it's accurate as of last year because we did not do this through the pandemic but it's a group visit program that i developed with maggie larson one of my colleagues here at the clinic for our obese patients with pre-diabetes or diabetes and thankfully in the past we've had support with group health and courts to actually offer active and engaged participants 100 to 200 as part of their annual wellness incentive in the past so slightly different than the meal kit concept but born out of the pandemic is cook it forward a collaboration between downtown restaurants to produce restaurant quality meals individually package them and then deliver them to pantries and other community locations um their meal cost is ten dollars this price allows them to actually pay the staff within their restaurants fifteen dollars an hour during a time actually when they would have been sent home or otherwise idle um so when the restaurants could have been empty um and pretty much are empty cook it forward still takes advantage of that local farm supply chain their distribution network and delivery network that they have and and lifts those up in in this model so several donors in the community also support this mission and then um little john's got a little bit famous here recently but they create chef quality meals for individuals of any means um as well as for meal programs like the boys and girls club and other nonprofits that have uh um programs like that the model's a little different than cookie ford in that they use grocery excess for that food that might otherwise go to landfills and as you can see in the diagram here uh 25 million americans could be fed in that regard so once their restaurant opens just up the road from us in fitchburg off of verona road dinos will be able to pay what they can for a meal with some paying it forward uh by paying for others and compared to the nine dollar cost of meals on wheels little john's five dollars meal cost is a result of this community collaboration and synergy um and if you didn't learn about morgan's lemonade stand and president biden's inauguration like good for you morgan um she's an eight-year-old girl from belleville just up the road here with a big heart who's already been able to raise over fifty thousand dollars for this mission um and boy that's that's pretty inspiring good for you morgan um so let's um let's just take these local meals a step further and do something to them to medically tailor them for specific medical needs that's basically what a medically tailored food is so the food is medicine um i guess evidence based if you want to call it is growing medical meals or medically tailored meals mtm as i'm referring referring to them here for people that have pretty significant chronic disease and disabilities in particular we of en in healthcare refer to those as the dually eligible those eligible for both medicare and medicaid that's where the evidence base is strongest but i think the business case can be pretty simple even for a simple uh one track mine like i sometimes have a single readmission when somebody gets discharged and then has to come right back thirteen thousand dollars whereas you can feed somebody with the examples that i just provided here at less than twenty dollars a day let me tell you a little bit more about the evidence on this because i think this matters to what we're talking about today so project angel heart they're a colorado-based um entity looked at medical claims data for individuals with congestive heart failure copd and diabetes again people that have fairly significant chronic disease they use the colorado all pains all payer claims database they found a 13 decrease as you can see in the top left here in 30 day readmissions and then further down a 24 reduction in total costs per member per month one that we often refer to in healthcare and insurance for those that receive these medically tailored meals um similarly community servings in boston um looked at outcomes using the massachusetts all payer claims database they estimated that um uh as you can see here an individual monthly health care savings of 753 per person per month i'm gonna bring you a step further now and say that's almost enough to cover through those health care savings that's just about enough to cover the 782 expanded 51 expanded monthly food share benefit um so based on programs like i described the bipartisan um policy center recently did a simulation of high-risk medicare population with conditions like i described here if they had two or more of these if they had a functional limitation as well put them into this model and said what would happen if these folks got fed how many fewer ed admissions would they have how many times would they go less to the hospital how less frequently might they be admitted to a skilled nursing facility turns out they identified flashing yellow lights here that a dollar 57 in savings occurred for each dollar that they spent on this uh very large um simulation that they did so mom's meals is in iowa based iowa i don't like iowa for a lot of reasons sports in particular but in this case just because of the geographic differences so mom's meals is an iowa based medically tailored meal provider and is what some local health insurance companies offer including our courts medicare advantage actually um and there's a 14.95 delivery fee so when you factor that in these work out to be about nine dollars per meal and if you consider little john's five dollars per meal cost as well as the environmental benefits of the reduced food waste um or you consider cooking forwards ten dollars per meal cost with simultaneously um supporting restaurant staff the local farmers the distribution network maybe just maybe gained by local maybe local programs like these uh might be a way to offer medically tailored meals during and after the pandemic with a little bit more community collaboration and investment um so here's a little more on the court's medicare advantage coverage for mom's meals it's a great benefit as 20 meals are provided that's a few more than typical actually so at time of discharge up to 20 meals provided and they do that up to four times per year for these medicare advantage plans four of the five actually cover that um and and i'll i'll be honest i think it's one of the reasons along with many others why we are a five-star plan that is courts medicare advantage and it's one of the only in the country and they get that rating from cms it's programs like this that make that happen and i don't know if jonathan jaffrey is on today but our accountable care organization could likely harness um i'd say even more savings with more members eating good food right so the outcomes using medically tailored meals are even greater when the meals come with ongoing personalized nutrition advice a home-based transitions team and nurses and others so i think we're close to being able to pull some of this together here in our community the referral form is pretty straightforward and now you know it's just a matter of awareness it exists so now you know refer those patients uh when it's appropriate and again wouldn't it be amazing to see local insurance dollars lifting up cooking forward little john's and others you know rather than iowa based company and they're shipping et cetera that doesn't do anything for our neighborhood our local economy um i've been working with courts probably over the last six to 12 months actually to to think through this business case um and hopefully we'll see an added benefit maybe as soon as 2022 in dane county for the non-medicare population to receive a benefit like this other variations on the food is medicine theme are the fruit and vegetable prescription programs and medically tailored groceries just a slight variation here in that these are used for food insecure individuals who have these chronic diseases but have the ability to cook for themselves and prepare their own food pennsylvania-based geysener i'm kind of giving you a little smattering of different regions in the country but pennsylvania-based geysiner has what they call a fresh food pharmacy pretty fantastic where they prescribe fruits and vegetables rather than insulin and it's led to a cost savings with an investment of about a thousand dollars per family per month that return is 24 000 in health care savings per family per month silence i feel like i could drop the mic on that one that's pretty impressive um we had a small fruit and vegetable prescription pilot several years ago out at the northeast clinic in partnership with the city of madison a wholesome wave as you can see here in the willy street co-op and assuming this evidence base remains strong which actually it needs more work it needs randomized controlled trials etc but assuming it remains strong and the evidence does evolve i honestly feel we should keep investing in refining these programs locally i continue to advocate uh mary pack if you're on today that our insurance companies should spend more on um these prescriptions than insulin in the future so let's let's try to do that someday which clinic lobby do you think patients associate more with whole health the verona clinic on the top left or the bottom right practically speaking we might um not be able to put fresh food pharmacies in all of our clinics around town but maybe we could install farmer's fridge vending machines in our lobbies to facilitate distribution of this food to individuals of any means we also need to continue to make hospital meals and cafeteria food healthy and attractive uh while simultaneously lifting up our local producers i i give uw a lot of credit they consistently are looking for opportunities to do that so thanks culinary nutrition partners if you're on today um and if you weren't already aware we actually do have a critical access pantry at uw i forgot to mention that earlier um but that's for some of our patients at the time of hospital discharge who are identified with those certain high-risk conditions and we can give them a couple days worth of food when they leave the hospital getting close to the end here so before we wrap up i want to share with the madison area food pantry gardens have been up to during the pandemic melissa mentioned i've been involved probably about 15 years as a volunteer with my family and i serve on the board as the volunteer development director and as a non-profit we have grown and gleaned over 2 million pounds of fresh produce for the dane county emergency food system and that's primarily in this network of several gardens as you can see here in madison over the past 21 years we usually have about 700 volunteers a year and on the bottom right here you might recognize some of those spaces working in the verona clinic uh garden the little garden that could that grows generally about 1200 pounds of tomatillo and other culturally appropriate produce for the badger prairie needs network each year um we have really great relationships with several pantries and other food programs in the community um and in 2020 we distributed to uh 19 different programs 84 000 pounds of this fresh culturally relevant produce and in 2021 we expect to contribute up to 23 different uh programs and we'll add what we have here bethel lutheran church downtown cook it forward little john's and through our expanded footprint out at forward garden at the uh pope farm homestead in the town of middleton we'll be adding about three to five acres in production this year so hopefully up to 125 000 pounds of food will contribute um sorry uh so in order to offer um i can't remember if it was mega or michelle earlier but these single serving things you know are really real this year in the distribution network and so in order to offer single serving produce to match these distribution needs of our pantry partners during the pandemic we put together about 800 steamer bags of broccoli cauliflower and green beans thanks to many community partners who worked together to support this effort and included uh chef kara i don't know if you're on today from promega and her team the culinary team there packing skills as you can see in the top right with our uw health dietetics interns there we were at the lucha food pantry packing in the middle here is my daughter alexa who has down syndrome and she was uh actually applying bilingual steamer bag labels during a virtual ot session uh via zoom this year i was so proud of her um but with the right setup and support individuals with many different abilities can obviously contribute to efforts like these so as part of our community needs assessment our farm manager just distributed a produce preference survey i developed with input from several of you on the line today several community partners we're asking pantry guests directly actually along with the pantry produce produce managers and other leaders there to select what fruits and vegetables they would like to receive in the future and in what form this age of several it's also available in spanish and the hmong community has provided regular feedback on this as well but not only will it influence what we continue to grow but it's going to guide our steps in collaboration with several of those community partners i've alluded to here earlier who can cut it they can bag it they can bunch it more so second harvest is also going to use these results to inform their season's plantings from some of the farms that they buy some of their produce from and as mega alluded to they got that significant grant to expand their refrigeration space refrigeration in the emergency food system is minimal i mean there's just definitely not enough and it's partly what explains why we have 40 percent of the us food supply going to landfills rather than helping those in need most of our madison area food tantra gardens produce gets the panther gas within 24 hours of when we harvest it and occasionally we'll hang on to it for a day or two because the pantry distribution limitations we've already described today and their hours restrictions etc but um as several of you know my my gear header my mechanical engineering degree sometimes comes in handy and this past summer i helped design and build a walk-in cooler at ford garden which is those 12 acres i referred to earlier and although the cooler is in this dilapidated uh machine shed it keeps our produce ultra-fresh for our pantry partners using a simple window air conditioner and a fancy controller i found out in california from a company that forces it to go colder than it's supposed to so pretty excited that next comes solar power to take it off the grid just about done here today guys thanks for keeping with us looking to the future we're going to improve accessibility at our gardens we'll be adding some raised beds hopefully we'll get some of these track chairs at least one of them from accessibility wisconsin which is a non-profit over at mcfarland um and with continued innovation and collaboration i'm grateful to the partners who have stepped forward to think about with us including some of my engineering colleagues how we might have some year-round growing capacity it's great that we submit you know to the food pantry system what we do but that's primarily may through november what would it look like if we did it all year round and so on the right is a vertical hydroponic system designed by an engineer out in singapore and then we also though have really excellent expertise in wisconsin we've got superior fresh up by black river falls we've got some awesome research going on over in nelson and paid and stevens point chris the professor up there they're looking at how they can put walleye into the hydroponics or the aquaponic system superior fresh uses salmon i don't know of an emergency food system in the country that supplies these of those fish but maybe we're not that far from doing it here in dane county one more slide to overwhelm you with here so dane county eats healthy is an evolving collective vision that i've developed over the last several months maybe even the last several years actually that relies on community collaboration to increase the emergency food systems less fresh local produce supply lightly process it and distribute it with these coordinated transportation logistics as healthcare providers providers like us that are trained to work in public health models like this i challenge you to get involved in at least one of the spokes around this wheel that support this central mission um the wheel can't turn without everybody working together um i'm going to skip over this slide you can take a look at this one later because i'd rather focus on this so if you're like me probably stopped seeking daily news with all the negative press lately but i did want to share you uh this piece that i saw in mundanemadison.com so this is uh ellie and her daughter zaya that live up in oregon just up the road from us here and here they're in their front porch talking about their food pantry they've set up so you can think of this definitely as a pop-up in their front porch they've got boxes from this past summer that they basically started with that now transitioned into this mini grocery store every day 6 30 a.m they flip on the lights unlock the door close it down at 9 30 at night people can come and grab what they need they serve about 10 to 12 people each week out of their front porch if that's not inspiring they don't know what is um it's going to take all this and a whole lot more to support these 60 000 people we just described here in dane county and although this um i don't know what you want to call it but a long collaboration chain maybe um at the end of this is a supply of healthy food delivered with uh with dignity to those in need and a vision that dane county eats healthy is truly cultivating the wisconsin idea and greater things are going to be done yet in this city so thanks everybody for listening in we can probably spend some time on some questions melissa yes so thank you all so much uh very inspiring um i thank you i if you want to put questions in the chat uh feel to feel free to do that now uh we'll start with the question um you touched on it a little bit you in both maggie but in terms of the how food voice plays into this discussion maybe if you touch mandy a little bit more just on the complexity and all of what's been involved in the partnerships uh such as with epic that it does sound like a very easy thing to do but uh in reality it's pretty complex yeah absolutely um what one of the things that we are able to do and i'm not even sure because it the this this relationship with epic predates uh my time at badger party needs network but um we are able it used to be before we closed down we were able to drive over to epic and and just pick up the food that they otherwise maybe would have had to toss out into the garbage um and and we they freeze it for us and we bring it back and we're able to take it into our commercial kitchen and because we're a licensed facility like a licen ed commercial kitchen we're able to repackage that food into um because it comes to us in big you know serving trays um and so it's a little bit unwieldy to to give to a family they don't want a big lasagna pan right we kind of divvy it up into smaller um smaller portions so that we can give it to individuals especially seniors and those that maybe don't have the ability to cook for themselves um so we try and give them a little bit smaller portions to be able to um just heat and eat it makes it really easy um and and so that's that's how we save that food from going into the landfill which is it's great and ryan um another question uh what's the best way to equip slash mobilize others to help in this season wow big question um i can speak for the madison area food pantry gardens i was really grateful for order number 13 where we can have um up to 150 gather outdoors now which is fantastic we were limited this last year actually uh with 25 to 50 people um and so in that regard that's a great way obviously um what i hoped to be able to provide today is if you had one dollar where might you commit it you know and who might you lift up if you wanted to provide finances besides your volunteer time and then you know thirdly i think um we all have a cognitive load up there that we can offer ideas um i saw lou santor you were saying hey why not geothermal uh to do year-round hydroponics like iceland yeah it's out there and why aren't we doing those things here so i think the more we can um collaborate and create standardsy out of particularly in dane county i mean we are so blessed with resource it's just a matter of putting the teeth and the gears together to mesh so that the wheels can turn um and so you know i think several people always have great ideas and they're just reluctant to bring them up because maybe they're too big or maybe they're impossible but i think we're proving that we're beyond that here in dane county i would also say that you know volunteering is still something that uh that we need um i'm i'm i don't i maggie can speak to what they need as well um we um at second harvest we have three locations we have a location in stoughton we are at the lion energy center and we're here um on dairy drive in madison and we um we have a lot of work to do we do a lot of pre-packing a lot of sorting i mean we're we're um we're dealing with lots of food and a lot of work that needs to be done um and we are able to do it safely um we we we do it socially distanced we um we have a lot of um parameters you know masking and and temperature checks everything um and we um we we have a lot of work that needs to get done in order to get the food uh ready to go before it goes out to our partner agencies and to our mobile pantry so um uh we we would love to have more help to get to get that food ready to go there's information on our website about that um and you know the um another point about about food waste is that um you know there's a lot of food out there that that is good on its dates and we have to move it really quickly and it's it's one of the challenges that has come up uh lately in in food rescue and food recovery is that prepared foods and things like when like the items that we're getting they have to go out really quickly and doing a lot of prepackaged items it's it's challenging to move some of that food that we used to be able to do in kind of a choice model because we're getting it and trying to pre-pack those boxes without knowing who's going to get that box it can it can be challenging but there's you know on a national level we're doing a lot of food rescue as well and so as a network uh you know i think i think people think a lot of food about food waste on the restaurant level and i think that's some of the hardest to do and i'm so glad that that um badger prairie needs network is doing that on like the the um the level that that's one of the hardest types of foods to to recover and that that um that that work they're doing to to to recover that kind of food is amazing um we're also doing this national you know nationally there are there are truckloads of produce that just aren't going to get to where they need to go and we're bringing in those truckloads as well second harvest dealt with about 12 million pounds of food last year that would otherwise go to waste and some of that's on a national level as part of the feeding america network so food waste happens on all sorts of levels and keep in mind that not all the food that's wasted in the united states is recoverable and we we we handle as a network a lot of things that we can't distribute and so when people talk about zero waste and and and things um we're not able to zero waste ourselves because we have a such a vulnerable population that we serve the people we serve are often more susceptible to foodborne illness because of their age their their health the amount of nutritious food they get on a regular basis and we we have to be really careful about the types of food distressed food we get food that that has you know not been labeled properly and we we do have to err on the side of caution and so the food i smell the milk at home and i'm like oh it smells fine but here we can't do that we have to be pretty careful and cautious so that we can protect the people that we're serving so there are some things that it breaks our hearts we can't distribute and we know we have to to discard some things but we want to be extra careful about protecting the people that we're serving even if we can extend some dates on things it's challenging and it's heartbreaking on some of the things that we're that but yeah it's we we have to be pretty careful on things oh thank you i think um what time you've got time for one more question and this is from uh jonas lee um of course amazing work are there any restaurants in low income neighborhoods that are being supported um thinking about culturally appropriate food i could see some of these ideas as being very foreign to some of our low-income patients jonas i can't answer that question specifically other than i can say for example one of the distribution locations that cook it forward would distribute to would be like kennedy heights neighborhood center baby foundation and other sites that are not traditional restaurants but traditional community locations that people would relate to and be more comfortable with right within their neighborhoods and so i think the idea is bringing something that's a little bit uncomfortable to a comfortable place is kind of the idea here and i think the three of us on presenting today as well as others that we work with you know it's all about dignity it's all about cultural relevance it's all about trying to do what's right for everybody and that there should be no halves there should be no have-nots we together you know sort of need to uh grow in the same direction on making this a very normal situation to have good food so that's a great question jonas and i'd like to continue to work with you to discover a little bit more about the communities particularly that you serve