Pharmacists Can Play Vital Role in Improving Access to Nutritious Foods

In an interview with Pharmacy Times, Anusha McNamara, PharmD, BCACP, ambulatory care pharmacy supervisor at the San Francisco Department of Public Health, and Erin Franey, MPH, director of the Food as Medicine Collaborative, discussed the food as medicine movement and how pharmacists can be involved. Food pharmacies, in particular, can be a great opportunity for pharmacists to collaborate with other providers, improve access to nutritious foods, and find unique opportunities to counsel patients.

Q: How exactly does nutrition impact overall health?

Anusha McNamara, PharmD, BCACP: Poor nutrition is a root cause for many chronic diseases such as hypertension, diabetes, heart failure, the list goes on, and so having good nutrition, good access to good, fresh, nutritious food is an antidote and answer to the management of a vast majority of chronic diseases.

Erin Franey, MPH: I would say in addition to that, we also know that food impacts, I would say, health in even broader ways. There's both chronic conditions; we also think about mental health, kind of social well-being, the kind of familial community health, that having that access, and the ability to eat really high quality really nourishing, culturally relevant food has so many benefits to local communities, as well as to like an individual persons kind of body and lived experience.

Q: What is the Food as Medicine movement and what's the history of it?

Erin Franey, MPH: For us, so, I work for a small organization called the Food As Medicine Collaborative, we see ourselves as a multi-sector coalition of clinics, hospitals, and health systems, as well as food businesses and nonprofits, advocacy organizations, and others who are really invested in connecting healthy food to health care. So when I think about “what is food as medicine,” I think it's that real integration of healthy food into health care delivery, and for us, there's a real focus on the kind of systems and policy change required to do that. What does it really take to operationalize a program, so that it's not just a short term, grant funded experience for a handful of folks, but is really, again, I've heard of just ongoing primary care delivery, and, and I think, broadly Food As Medicine interventions are really used to prevent treat, and in some cases, even reverse a whole range of chronic conditions that Anusha described, and the history, oh, my goodness, well, I think there's this long and rich history of peoples and cultures throughout the world using food as a way to heal and treat and again, prevent and support their own health.

I think within the kind of US health care context, there were a couple of leaders early on discussing our health. There's also, in Massachusetts, a therapeutic food pantry at, I think, Massachusetts General, that both of those I think are often seen as kind of early innovators in this space. For us, our food pharmacy program was first pilot in the San Francisco Health Network in 2015, and has really grown and developed in the years since then. I think just finally, at a kind of national and policy scale, there has been increased interest in insurance, both public and private, covering food as a medical benefit. I believe either Massachusetts or North Carolina were the first states to do that, and that started back in either like 2018 or 2020. Then California could have joined that movement by offering food as a covered community support through our Medicaid waiver in January of 2022.

Q: What are Food Pharmacies and why are pharmacists increasingly involved in nutrition efforts?

Erin Franey, MPH: Food pharmacies are co-located healthy food and kind of other resources related to cooking and nutrition inside clinics with really the goal of improving overall health and management of chronic conditions as well as advancing racial health equity, particularly within a San Francisco health network clinic, and we think about kind of 5 components to food pharmacy, there's actual access to groceries, so we set up food pharmacies, often in this kind of farmer's market style. When a person walks in what they're seeing are these abundant baskets, and bins of produce, as well as other food items that they're getting to pick up and smell and taste and choose and take home. There is the kind of knowledge and education piece so we often partner with nutritionists at clinics who are doing cooking demonstrations, providing taste tests, and giving out recipes for folks to take home, especially if something might be unfamiliar to people. Eggplant is a common one. A lot of folks are intimidated by eggplant. So given ideas there.

We think about them like skills and tools, so really helping people develop their skills around cooking, as well as providing actual equipment, so crock pots, cutting boards, other things that a patient might need to be able to prepare food where they live. And then, community connections, and for us, that's both connecting patients to other food resources that they might be eligible for so SNAP, or WIC, local community-based organizations, as well as building really a peer support community within food pharmacy. And then lastly, really building trust and repairing trust between that patient and their clinic and providers at the clinic. So food pharmacy, we really see as its comprehensive program that's really working to address kind of food and nutrition insecurity for patients, and then really improve their health kind of through the process and Anusha and I were just talking about how we sort of see food pharmacy as like a door, where it is like an access point to health care and engagement in the health care system, that there's so many, I think, historical, systemic reasons why patients maybe aren't as engaged in health care, and that this can really be a tool for folks to really build those connections.

Anusha McNamara, PharmD, BCACP: Pharmacists are a key member of the health care team. In our primary care teams, we have primary care providers, nurses, RNs, MBAs, social workers, pharmacists, and so pharmacists play a key role on medication management for improving chronic disease, and so medications, and nutrition, and exercise are 3 components that can really help improve chronic disease management. It just really makes sense for it to go hand in hand, and the reason why pharmacists being involved in food pharmacy, like Erin was saying, that like the food pharmacies play a big role in patients who don't engage in care to have a reason to engage in care. Then the other piece of it is getting patients who need the right resource to that resource, so patients who are being recruited for food pharmacies often have uncontrolled chronic conditions, and so pharmacists are the perfect person on the team to be seeing those patients with that uncontrolled chronic condition. When we're talking to patients, we're talking about diet, exercise, and medication, so we have the opportunity to say yes, diet is an important part and also here, like the food that you're going to get from today is part of your care and I'm also going to adjust your medications.