COVID and the Food Insecurity Epidemic

Larisa Gearhart-Serna will be focusing on measuring the effectiveness of a fresh produce delivery program for food-insecure patients in the Triangle during COVID-19 with Farmer Foodshare.

During the COVID-19 crisis, food insecurities have been exacerbated, and community members are turning to nonprofits for emergency aid. Local farms are also struggling. Farmer Foodshare, the organization I am working with, sources fresh local produce from local farmers for distribution to those in need. Food insecure patients from the Duke Outpatient Clinic (DOC) are referred to the Farmer Foodshare program, which packages and distributes weekly bags of fresh produce to these patients.

The patient population served by the DOC is disproportionately poor, black, elderly, and affected by chronic diseases including diabetes and heart disease – all significant risk factors for COVID-19 co-morbidity. Their risk factors, combined with pre-existing mobility and transportation constraints, make it difficult and unsafe for these patients to go out to grocery stores for food. In turn, this hindered access to healthy food threatens the ability of the patients we serve to manage their diet-related chronic health conditions.

Since August 2017, Farmer Foodshare’s partnership with DOC has provided packages of fresh produce and food education materials to patients experiencing food insecurity in Durham. Before the COVID-19 outbreak, patients would visit the DOC for these resources. Since the COVID-19 outbreak, patients now receive fresh food and educational hand-outs delivered to their doorsteps biweekly. The hope is that supporting food security with fresh, local food can mitigate the effects of environmental health factors and their contributions to this population’s risk for COVID-19 infection.

I started working with Farmer Foodshare at the start of the COVID pandemic when they were in desperate need of more distribution day packaging and delivery driver volunteers. I am passionate about food insecurity issues having grown up in a low-income, minority, food insecure background. My biomedical education has also taught me a lot about the health issues connected to such food insecurity. Given my background as a biomedical scientist and PhD candidate, Farmer Foodshare brought me on board as a research co-coordinator in September, to analyze data from patients in the fresh produce distribution program pre- and during COVID. I was overjoyed to be integrated more fully into the organization and to put my skills to good use, toward moving their work forward.

I will backtrack and say that, as a PhD candidate with her own research, I had limited time to dedicate to Farmer Foodshare efforts like I wanted to have. Although I was onboarded as a research co-coordinator, much of the work I was able to do had to fit around my PhD research and other work. This fellowship allows me to have protected research time to dedicate to them, which is nothing short of a Godsend. Because of the time I can now devote, we are working on a manuscript and data figures that would never have otherwise been possible since it is very analytically intensive. Preliminary results are very promising and allude to the additional food insecurity and stress COVID has brought to our most vulnerable patients, but that the fresh produce program is helping. 88% recipients of the weekly produce deliveries agree or strongly agree that they have benefited from the program, which is gratifying.

This work is ultimately important because obesity, diabetes, and heart disease occur at a higher frequency in low-income communities for a variety of reasons, including lack of access to and inability to afford healthy foods. It is important that clinics address these upstream factors in order to keep their patients healthy. In Durham, food security is estimated to be 19.1 percent, higher than the average of 18.6 percent in the state of North Carolina. Food insecurity predisposes patients to eat calorie-dense foods high in fat, salt, and processed carbohydrates, which all contribute to poor health outcomes. Additionally, as discussed previously, the COVID-19 pandemic has exacerbated the inability for low-income communities to have access to nutritious foods.

It is pertinent to allocate resources to this at-risk population. My research with the organization aims to examine the biweekly delivery of fresh produce and shelf stable items to low-income, food-insecure patients, in hopes of increasing food security and reducing perceived stress levels. If the collected data confirm the intervention to be successful in increasing healthy behaviors and reducing patient stress, especially during strenuous times such as during the COVID pandemic, it could be expanded to other communities to address food insecurity and improve health outcomes among a wider patient population. Thus, the data analysis project that I proposed for this fellowship and culmination towards publication will be instrumental towards showing efficacy of the FPP, new grant development, and pursuing funding to continue to reduce food insecurity in Durham and beyond.

I hope that this project will further serve as a demonstration of the power of home delivery of fresh produce as a health-promoting activity. Providing effective services now, especially during the COVID pandemic, is an incredible step and will help Farmer Foodshare and peer organizations in advocating for and refining food-as-medicine interventions.  Together we will empower and equip the community to turn the tide of community health!