Addressing Food Insecurity at Los Angeles County Clinics; Los Angeles, California
Connection to Moving Health Care Upstream
The Los Angeles County Department of Public Health (DPH) serves as the lead organization for the Los Angeles team in Moving Health Health Care Upstream's 2017 and 2018 Policy Learning Labs focused on food insecurity. DPH is one of three departments that is part of the Los Angeles County Health Agency, which consist of Department of Health Services (DHS) and Department of Mental Health (DMH). The mission of DPH is to advance the conditions that support optimal health and well-being for all persons. DPH collaborates with community partners, organizations and stakeholders across sectors to address social determinants of health. This Example in Action spotlights collaboration between DPH and DHS to address food insecurity across Los Angeles County.
Our Community and Need
Los Angeles County is home to more than 10 million residents. Despite being known for the wealth of the entertainment industry, Los Angeles County has the highest rate of people living in poverty in the state of California.[1] Specifically, wealth is unevenly distributed across different racial and ethnic groups in the County. In 2012, about 25% of African-American, Latinx, and Native American/Alaskan Native County residents lived below the Federal Poverty Level (FPL), as compared to about 10% of white residents.[2]
Many low-income families face barriers to purchasing healthy foods such as fruits, vegetables, lean meats, and foods high in fiber. Food insecurity is a complex social condition that affects health. Because poverty and food insecurity frequently go hand in hand, families often must choose between affordable housing, health care, and healthy foods for their families. In 2017, DPH released the Food Insecurity in Los Angeles County report, and found that more than half a million Los Angeles County households, or almost 30% of households with incomes less than 300% of the FPL, experienced food insecurity in 2015.[3] Additionally, 11.3% of these households with incomes below 300% of the FPL suffer very low food security, which refers to experiencing disrupted eating patterns and reduced food intake. Over two-thirds of Latinx households in this income category experience very low food security, followed by 14.7% of whites, 10.6% of African Americans, and 6.6% of Asians, respectively. The report also found that the proportion of adults with chronic conditions of obesity, diabetes, hypertension, high cholesterol, and current depression was higher for each condition among those living in food insecure households compared to those living in food secure households. [3]
In September 2017, we held a press conference to highlight the findings in the Food Insecurity in Los Angeles County report and discussed recommendations to improve food security, including screening patients at health care clinics and referring them to food resources. Recognizing the negative health impacts of food insecurity on LA County residents, the Los Angeles County Board of Supervisors passed a Board Motion in December 2017 directing DPH, DHS and the Department of Public Social Services (DPSS) to conduct an assessment of the feasibility and costs of integrating a food insecurity screener into the County's electronic health records system, implementing an action plan to establish a referral system to CalFresh, WIC, and other food assistance programs, and conducting nutrition education classes focused on food resource management.
Prior to the release of the food insecurity report, we had established a rapport with a DHS outpatient facility, Hubert H. Humphrey Comprehensive Health Center, located in South Los Angeles. Compared to the County average, residents in the Hubert Humphrey area are significantly more likely to have a household income below the FPL (18% vs. 34%).[4] After several discussions with Hubert Humphrey leadership and other stakeholders, food insecurity was identified as a health concern for its pediatric population.
In June 2017, we piloted the 2-item Hunger Vital Sign screener at all well-child visits at Hubert Humphrey's pediatric clinic and referred positive screened patients to the onsite CalFresh enrollment office.
As a result of the Board Motion in December 2017, we were able to allocate more staff and resources to the food insecurity pilot. In addition, DPSS was able to assist in tracking the number of CalFresh referrals and enrollment.
From screenings completed from January 2018 – December 2018, we found that rates of food insecurity at Hubert Humphrey were nearly 32%, which is higher than County's food insecurity rate (29%)[3] but is consistent with the findings from our food insecurity report for South Los Angeles. We also learned that enrollment in federal nutrition assistance programs such as CalFresh did not always eliminate food insecurity. Out of 493 screened patients, about 20% were food insecure and already receiving CalFresh. Similarly, about 10% of patients were food insecure and already receiving WIC. Those who were screened were also referred to the onsite CalFresh office and given a list of food pantries within a 5-mile radius of the clinic.
We reported to the Board of Supervisors on our progress and lessons learned from the Hubert Humphrey pilot, and provided a timeline and implementation plan for expanding the food insecurity screener to all DHS and DPH clinics. In January 2019, the 2-item screener was integrated into the County's electronic health record, ORCHID. As of Fall 2019, we are in the process of training County nursing staff, community health workers and other clinic staff on the screener and tracking their referrals through the online community referral platform, One Degree.
Community Partners for our work with MHCU
Community partners for our work with Moving Health Care Upstream include Hubert H. Humphrey Comprehensive Health Center, the Los Angeles County Department of Public and Social Services, and the Los Angeles County Department of Health Services.
For more information about the upstream work happening in our community, please contact Fatinah Darwish at fdarwish@ph.lacounty.gov.
[1] Sarah Bohn, Caroline Danielson, Tess Thorman (2018) "Just the Facts – Poverty in California," Public Policy Institute of California, Accessed May 7, 2019. https://www.ppic.org/publication/poverty-in-california/
[2] California Pan-Ethnic Health Network, "Income Below Poverty Level (Los Angeles County, 2012)," Accessed May 1, 2019. https://cpehn.org/chart/income-below-poverty-level-los-angeles-county-2012.
[3] Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology, Food Insecurity in Los Angeles County, September 2017. Accessed May 7, 2019. Available at http://publichealth.lacounty.gov/ha/docs/2015LACHS/LA_Health_Briefs_2018/FoodInsecurity_REV2018.pdf
[4] Los Angeles County Department of Public Health, (2017) "Key Indicators of Health by Service Planning Area," Accessed May 7, 2019. http://publichealth.lacounty.gov/ha/docs/2015LACHS/KeyIndicator/PH-KIH_2017-sec%20UPDATED.pdf
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