Food insecurity has long been recognized as a social issue that has direct and measurable effects on the physical health of community members. It often coexists with financial instability, inadequate housing, reliable utilities, transportation and income.
The problem hits especially close to home for Rush University Medical Center in Chicago. Located on the city’s near west side, the academic medical center is close to communities that have long faced structural barriers to food access. Estimates before the public health emergency were that more than half a million neighbors on the West Side had difficulty accessing nutritious food, which exacerbated other health problems. The geographic proximity of Rush to these communities made the issue both visible and urgent.
“We’ve known for years that the conditions under which people live, work, play and pray affect their health,” said David Ansel, MD, MPH, an internist and senior director for community health equity at the Rush University System for Health. “For example, we found that food insecurity patients’ blood pressure was six times higher, and every point of hypertension control was a two-point chance of reducing cardiovascular mortality.”
Improving access to food aligns with Rush’s broader goal of closing the 20-year life expectancy gap between the city’s Loop and North Side neighborhoods and communities to the South and West. Residents of these areas also experience disproportionately high rates of hypertension, diabetes and heart disease.
The goal was not to simply provide temporary relief but to create a stable model within clinical care. In 2022, Rush’s Office of Community Health Equity and Engagement launched its “Food Medicine Veggie Rx” program.
Julia Bassett, PhD, Senior Director of Health and Community Benefits at RUSH, said, “The Food Medicine Program plays an important role in addressing food insecurity and food-related health disparities among RUSH patients.
“By improving access to fresh produce and promoting healthy eating habits, the program supports better nutrition, which can help improve disease management, more energy and quality of life, and fewer food-related complications,” Bassett added.
The Rush University System for Health is part of the AMA Health System Member Program, which provides enterprise solutions to align resources with leadership, physicians and care teams to help advance the future of medicine.
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The operational foundation of the program is to institutionalize the entire process by Rush, from initial screening to resolution, and embed it in common practice and care. All patients are routinely asked a set of standardized questions that include questions about any social needs that may affect health, including depression, violence, access to housing and food. Positive tests for all of these factors are entered into the EHR, and those around the food are immediately referred to the Food Drug Pantry.
“People appreciate that we ask them these questions,” explained Dr. Ansel. “It’s all part and parcel of holistic care and what it’s like to be sick in a rush.”
The pantry’s location in the primary care setting, in a separate off-site location, makes it easy for patients to “shop” on the same day as a routine clinic visit and is designed to feel less intimidating. Patients are welcomed by community health workers in a setting that is collaborative, supportive and respectful.
Rather than simply being handed a prepackaged, potentially “one-size-fits-all” parcel, patients can choose fresh produce, healthy proteins and shelf-stable items that meet their needs, and suit their own families’ tastes.
“Patients can buy food directly from shelves, refrigerators and freezers, often choosing about 75 pounds of nutritious food to meet the needs of a family,” explained Bassett, adding that community health workers “also help assess preferences, provide encouragement and connect patients to additional resources when appropriate.”
Community health workers also enroll patients in a three-month home delivery of produce to ensure continued access to fresh fruits and vegetables after their first visit and connect patients to additional resources if needed.
System-wide and community partnerships
As screening expanded, so did awareness of the scope of the problem. While the program was initially designed to address the needs of the sick, Rush leaders soon realized that food insecurity was much more widespread, and closer to home, than they thought.
“Later we realized that some of our medical and nursing students were also food insecure,” said Dr. Ansel.
“Everybody knows that medical students and nursing students generally don’t have a lot of income and probably have a lot of debt, so now our students and our staff are able to access the program,” he said.
The program has since expanded from its initial clinic-based pilot on the main campus to include the entire Rush Oak Park hospital and emergency department system, where patients with immediate needs can access resources before discharge.
It also facilitates linkages with other sources of long-term food aid and existing public benefits. Patients who access the pantry are also screened for eligibility in the SNAP and Meals on Wheels programs. If patients are eligible, they receive assistance with the application process.
“Many people qualify for these programs and don’t even know it,” Dr. Ansel said. “So, if they come to the pantry, they can enroll in other food programs as well.”
Other efforts have evolved from the model. This includes a food supplement program that transports prepared meals from hospital cafeterias to homeless shelters, and partnerships with other community organizations, including the Greater Chicago Food Depository, Forty Acres Fresh Market, Top Box Foods and Devon’s Chicago Dream.
The Greater Chicago Food Pantry distributes food to two school-based health centers through a school delivery program: Orr High School and Simpson Academy. Forty Acres is an independent, Black woman-owned grocery business based on Chicago’s West Side, created specifically to increase access to affordable, high-quality fresh food in underserved neighborhoods without full-service grocery stores.
Meanwhile, Topbox Foods is a nonprofit in Chicago that offers free home delivery of nutritious and affordable food. And Dion’s Chicago Dream is a nonprofit organization that aims to improve health outcomes and center health equity through an industry-leading approach to addressing food security.
Rush is also partnering with an urban agriculture initiative on reclaimed land in a nearby food desert. Staffed by returning citizens and students, they grow culturally sensitive and appropriate meals for local residents each summer, reinforcing the program’s focus on culturally relevant care. They will also open a site at Sankofa Welfare Village, a community-run health campus designed to address chronic health inequities through integrated, holistic services. The space will feature a pop-up food pantry with nutrition education, healthy recipe sharing and live cooking demonstrations to help families prepare fresh, nutritious meals.
The health system is also a founding member of West Side United, a partnership working to ensure that communities on Chicago’s West Side can overcome social, economic and environmental barriers to staying healthy. The AMA is also a partner in the West Coast United Anchor Mission, which has invested $5 million in the effort since 2020.
Measuring impact and measuring accountability
The Food Medicine model isn’t just about distributing food to Rush and its leaders. It is about integrating measurable social care into actionable clinical care. Screening for health-related social needs is now a routine practice across the system and is tracked on the corporate dashboard.
Screening rates are now over 90%, well above the initial internal benchmark of 80%. In fact, leadership compensation is partially tied to achieving these thresholds, reinforcing that screening is not optional or random, but operational at scale.
“We never screened, and now we do,” said Dr. Ansel, “and as a result, we never prepared food, and now we do.”
Dr. Ansel and his colleagues believe the effects extend beyond hunger relief. By combining food access with nutrition education, behavioral support and digital remote monitoring tools, the health system is working to strengthen chronic disease management.
“We think that chronic disease needs to be addressed at several levels,” Dr. Ansel said. “There’s a good cycle here, and we’re still learning the best ways to do it.”
The program is still largely supported by philanthropy, although the creation of Medicaid waivers may create more sustainable funding streams for food-based health care interventions. Meanwhile, work continues through community partnerships, educational initiatives and digital health tools, including remote patient monitoring, a behavior change app and food tracking.
Dr. Ansel suggests that other health systems considering similar models start with the most basic fundamental step: screening. Once needs are identified, integrating food into care is not an ancillary service, but a clinical responsibility.
“We want the best outcomes and experiences for our patients,” said Dr. Ansel. “If you address health-related social needs as part of a daily visit, it opens the door to better outcomes and experiences, which is why we do what we do.”
Check out this interactive CME course that explains the basics of health equity.
Also, the AMA offers resources and custom support for federally qualified health centers and community health centers, which are a vital part of our nation’s primary care safety net and provide essential care in underserved communities and to those with limited access to health care.
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