Authors: Noah Berland MD, Adrian Aurrecoechea MD
Editor: Smruti Desai, DO
On October 5th, 2020, our Social EM Mini-Fellowship hosted a virtual journal club to discuss food insecurity in Brooklyn, and ways to address this at Kings County Hospital (KCHC).
Pre-COVID Emergency Food Use in NYC
Prior to the outbreak of COVID in NYC, 1.4 million NYC residents relied on emergency food programs (EFPs: soup kitchens and food pantries) annually. Roughly 1 in 5 of NYC residents relied on EFPs; among women, this number was 1 in 6. Further, 1 in 5 NYC seniors relied on soup kitchens and food pantries in 2019.[1]
Pre-COVID Food Insecurity in NYC
Food insecurity is defined as the inability to meet all food needs required to maintain normal nutritional goals or an active life. Prior to COVID, more than 1.2 million NYC residents (14.4%) faced food insecurity, with 1 in 7 children living in a food insecure household.. Approximately 370k Brooklyn residents (or 1 in 9) lived in food insecure households, the most of any borough. [2,3]
Figure 1
The Meal Gap represents the number of meals missing from homes as a result of inadequate resources to buy food. This has been measured per borough in NYC. Before COVID, the yearly meal gap in NYC was 208 million meals, meaning that New York City residents who experience food insecurity fall short of an adequate diet by 208 million meals in a single year, based on data from 2016 and 2018. In 2014, Brooklyn had 91 million missing meals overall, the highest of any borough in NYC. [4,5,6]
Food Pantry and Soup Kitchen Survey Data
As of 2018, 38.1% of food distribution sites reported inadequate distribution of food in comparison to the demand, with 86.5% reporting an increase in the number of people served by emergency food programs. More than 25% of food distribution sites reported having to either turn people away, reduce the amount of food distributed per person, or limit their hours of operation on account of inadequate resources.[7]
Our Local Community Needs Assessment
In the 2019 Community Health Needs Assessment produced by NYC Health and Hospitals for the catchment area served by KCHC, lack of access to affordable, healthy food was listed as an outstanding need.[8]
COVID has further taxed an already strained system.
Figure 2
Figure 3
As evidenced by the data above, food security in Brooklyn was already strained prior to the COVID pandemic. COVID-19 has had profoundly deleterious impacts on our communities, causing not only loss of life on a large scale, but also loss of jobs and livelihoods. Consequently, food security has been adversely impacted by the pandemic; 11 of 19 Emergency Food Programs (EFP) serving KCHC’s catchment area have closed in 2020.[7]
Feeding Kings County Initiative
“Feeding Kings County” is an initiative is an up and coming program designed to address some of the food insecurity that is a challenge to our patients and our community at large. Our measurable long-term impacts will include addressing the baseline lack of access to food but made even more important with the COVID-19 pandemic. We also hope to reduce wait times at current community food providers.
The initiative is based on a similar food box program that is currently operating out of Bellevue Hospital Center, a sister NYC H+H hospital. During the first two months of their program, Bellevue Hospital was able to distribute 3000 bags of food, including both uncooked groceries as well as cooked meals. As a result of its success, the program was expanded to NYU Langone Brooklyn. [10]
The overall flow of our initiative is designed to replicate the success achieved at NYU. Providers will ask every patient upon discharge: “Would you like to go home with a box of groceries?” Alternatively, a patient can request a box of groceries prior to discharge, based on prior knowledge or advertisement. Based on the patient’s requests, their existing co-morbidities, and other factors (availability of a stove, food allergies, etc), the provider can assess what groceries the patient may need. If the patient is interested, the ED provider retrieves a box of groceries from a storage room in proximity to the ER, and brings it to the patient free of charge. The provider can enter ICD 10 code Z59.4 (Lack of adequate food and safe drinking water) into the EMR, provide discharge information on access to food resources in NYC, as well as social work and/or case management if needed.
Finally, to close our riveting journal club, we brought to attention the presence of free community refrigerators in the Brooklyn neighborhoods surrounding our hospital. These refrigerators exist so that individuals can share groceries that they are not using with those who may benefit from them. Involving these refrigerators in some capacity with our Food Box program has potential for community engagement in the future. We have a unique set of neighborhoods that proudly call KCHC “their hospital”, and community resources such as these refrigerators remind us of how privileged we are to serve Central Brooklyn.
References
- 1. Research, Reports and Financials: Fast Facts. Food Bank For New York City. https://www.foodbanknyc.org/research-reports/. Published 2020. Accessed December 10, 2020.
- 2. Gibson A, Berg J, Aber N. The Uneaten Big Apple: Hunger’s High Cost in NYC, New York City Hunger Report, 2018. New York, NY; 2018. https://www.hungerfreeamerica.org/sites/default/files/atoms/files/NYC and NYS Hunger Report 2018_0.pdf.
- 3. Bellafante G. Brooklyn’s Food Gap. New York Times. https://www.nytimes.com/2016/09/11/nyregion/brooklyns-food-gap.html. Published September 9, 2016.
- 4. Stampas T, Koible WG. New York City’s Meal Gap 2016 Trends Report. New York, NY; 2016. https://www.foodbanknyc.org/wp-content/uploads/Meal-Gap-Trends-Report-2016.pdf.
- 5. Philippou C, Chidester M, Mallow M, DuBartell E. COMMUNITY HEALTH NEEDS ASSESSMENT 2019. New York, NY; 2019. https://hhinternet.blob.core.windows.net/uploads/2019/08/chna-2019.pdf.
- 6. Philippou C, Chidester M, Mallow M, DuBartell E. COMMUNITY HEALTH NEEDS ASSESSMENT IMPLEMENTATION STRATEGY PLAN Companion Document 2019, Brooklyn and Staten Island. New York, NY; 2019. https://hhinternet.blob.core.windows.net/uploads/2019/11/isp-2019-brooklyn-staten-island.pdf.
- 7. Koible W-G, Figueroa I. FIGHTING MORE THAN COVID-19 UNMASKING THE STATE OF HUNGER IN NYC DURING A PANDEMIC. New York, NY; 2020. https://1giqgs400j4830k22r3m4wqg-wpengine.netdna-ssl.com/wp-content/uploads/Fighting-More-Than-Covid-19_Research-Report_Food-Bank-For-New-York-City_6.09.20_web.pdf.
- 8. Jahnes K, Hopkins K, Foote E, Fleisher D, Doran KM. Food Bag Program to Address the Immediate Food Needs of Patients During the COVID-19 Crisis. Ann Fam Med. 2020;(COVID-19 Collection: Primary Care Pandemic Response). https://deepblue.lib.umich.edu/bitstream/handle/2027.42/156010/FINAL_Food bag program article_complete_7.2.20.pdf?sequence=1.
- 9. Fleisher D. Creating a Food Pantry from the ED During COVID-19. Medium. https://medium.com/case-notes-from-the-covid-19-front-lines/title-emergency-medicine-covid-19-food-pantry-collaboration-8072160936c0. Published 2020. Accessed October 13, 2020.
- 10. Rosa A. New York City’s Community Refrigerators Offer Free Food for Those in Need. New York Times. https://www.nytimes.com/2020/07/08/nyregion/free-food-fridge-nyc.html. Published July 8, 2020. Accessed October 13, 2020.
Noah Berland
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