Expanding ACLM’s Reach Through Strategic Partnerships

This article is one in a multipart series where the American College of Lifestyle Medicine (ACLM) President, Dr Dexter Shurney, introduces a key person or organization that will take ACLM to the next level through one or more aspects of the “4 P” strategy—Policy, Partnership, Payment, and Public Relations. In this second article, Dr Shurney Interviews Cathryn Couch, Chief Executive Officer of Ceres Community Project on Partnership.

DS: What is the Ceres Community Project and its mission? How are you a unique organization?

CC: Ceres Community Project’s mission is to foster health for people, communities, and the planet through healing food, love, and empowering the next generation. We do that through delivering community-based programs in 2 counties in Northern California, supporting replication of our community-based model through a National Affiliate Program, and by advocating for policy change in 2 areas—integration of food as a reimbursable health care expense, and promotion of organic and sustainably raised food.

Our community-based model, Healing Meals for Healthy Communities, brings young people ages 14 to 22 into 2 organic gardens and 3 commercial kitchens where they serve as the primary gardeners and chefs providing healthy, 100% organic medically tailored meals to low-income community members facing a serious illness. Among medically tailored meal providers in the country, we are the only organization providing 100% organic food, and the only one engaging youth as the primary gardeners and chefs. The other thing that makes us unique is that we use an environmental nutrition framework to guide our work. In other words, we understand that health for individuals is inextricably intertwined with the health of our food system and environment. We also know that social connections are huge drivers of health outcomes. Our model strives to reweave the webs of social connection at the community level, and to model for young people what a healthy community looks and feels like. Along with 450 youth, we engage 600+ adult volunteers each year along with hundreds of donors and community businesses and farms. Each of us is healthier for being part of the Ceres’ family.

We are also the largest provider of community nutrition education in our area. This year we’ll offer 85 nutrition education classes, including monthly classes at 2 federally qualified health centers, and classes through our county library system.

DS: How and when did you become involved and what is your current role?

CC: I founded Ceres Community Project about 12 years ago. The idea started in 2006 when an acquaintance asked me to hire her daughter in a catering business and teach her how to cook. Instead, I created a small project where this teen and I met weekly over the summer and prepared healthy organic meals for 3 families facing a health challenge. I knew that many young people were growing up in families where cooking from scratch wasn’t happening—and without cooking skills and an understanding of why food matters, these youth would be at the mercy of a profit-driven food system. And I knew that when people got sick—and most needed to eat well—it often went to the bottom of the list for a whole host of reasons: stress and the burdens of appointments and decisions, not feeling well, and access issues, especially for low-income people.

My background includes an MBA and work in marketing and marketing research in the for-profit sector, 4 years as the Director of Communications for a national nonprofit, and 10 years running the first organic home-delivered meal business in the San Francisco Bay Area from 1993 to 2003—long before the revolution that’s happened in prepared meal delivery and meal kits. Today I serve as Ceres’ Chief Executive Officer.

DS: Who makes up your members and what are their backgrounds? With whom do you partner with?

CC: Ceres Community Project serves clients and their families who are struggling because of a serious health challenge. The majority of our clients are living at or below 200% of the federal poverty level—$32 000 a year for 2 people. They are overwhelmingly women (72%), seniors 60+ (65%), and living alone (67%). In addition, 67% have a cancer diagnosis although we serve people with a wide range of illnesses including heart disease, diabetes, and hepatitis C. The youth we engage come from more than 60 schools, group homes, and foster care programs. Thirty-seven percent are youth of color, and about 25% face some challenge to success including learning or other disability, foster care status, or having been in the juvenile justice system.

Locally we partner with all of our health care providers, and especially federally qualified health centers. We’re active in 2 national coalitions—Food is Medicine and The Root Cause Coalition; 2 statewide coalitions—California Food Is Medicine and California Food and Farming Network; and 3 local collaboratives working on food access, food policy, and food and health. In our work on organic food, we work with Health Care without Harm, who have developed food procurement guidelines that include environmental impacts of food choices, and CCOF (the largest certifiers of organic farms), who are working on a policy platform to expand organic agriculture in California, and many companies in the organic food sector.

DS: How do you measure your success and how does lifestyle medicine play a role?

CC: We work to educate our community that much of their health rests in the choices they make every day. We love data at Ceres and include program evaluation as an ongoing part of our work with clients, youth, and adult volunteers.

For clients, we see statistically significant improvement on 8 out of 10 quality of life measures using the FACT-G (Functional Assessment of Cancer Therapy–General) validated survey. Clients increase fruit and vegetable consumption by 17%, and 70% of clients report that they’ve made positive changes in their eating habits as a result of what they learned from Ceres. Finally, 93% report that they feel more connected and cared for as a result of the meals.

Among youth who’ve been out of the program 2 years or more, 47% are cooking from scratch 4 times a week or more, and 78% describe their diet as mostly fresh food; 60% continue to be active as volunteers and 95% say their time at Ceres was influential in this area; and 58% are studying or working in fields related to Ceres’ work with 78% saying their time at Ceres was influential.

Gathering data about the impact of food on health outcomes requires partnership from health care providers. We’re very excite to be engaged in 3 different studies. We were instrumental in California’s decision to invest $6 million in a 3-year pilot of a nutrition intervention for MediCal patients with congestive heart failure. Along with 5 other medically tailored meal providers we will provide 1000 patients with 12 weeks of complete nutrition plus 4 visits with a registered dietitian. An outside evaluation team will use the MediCal claims database to look at health outcomes, health care utilization, and costs for our patients compared with a 4000 person control group. We are also doing a small pilot with Kaiser Permanente Santa Rosa Hospital providing meals to Kaiser members with congestive heart failure to see if we can reduce 30-day readmission rates. And we are doing a small pilot with low-income Latinx families who are at high risk of a heart attack or stroke. That pilot involves weekly nutrition education, medically tailored prepared meals, and healthy groceries, and is also looking to measure impacts on utilization and costs.

DS: What are some things in the Food as Medicine arena you have accomplished and you are most proud of?

CC: We are proud to have led the formation of the California Food as Medicine Coalition and the first statewide medically tailored meal pilot. We’re also proud to be leading conversations about food quality standards in all the coalitions we’re part of, working to raise awareness and commitment to food that supports the health of both people and planet. See our white paper, The Power of Our Food Choices (https://www.ceresproject.org/PDF/PowerOfFoodChoices.pdf), for more information about our food philosophy at Ceres and how we’re generating a conversation among food providers about food quality.

DS: What is your membership asking related to Food as Medicine, and have there been any big surprises?

CC: We’ve supported a dozen communities around the United States and now Denmark in creating programs based on the Ceres’ model. What we see over and over again, is that people who are sick know that the kind of food they eat matters. They want healthy, whole, and organic food—whether or not they’re in California or Nashville. Consumers are out ahead of where many doctors are, and are frustrated that their health professional is not talking with them about diet—and in fact, in many instances, is pushing calories regardless of quality.

DS: What’s on your agenda in 2019 related to lifestyle medicine?

CC: We are working in 2 main areas: (1) building the case for reimbursement of healthy food within health care through the 3 pilots we’re engaged with and our overall coalition work and (2) promoting an environmental nutrition framework that recognizes the health impacts of our current agriculture and food system, and promoting food quality standards including organic and regenerative within the Food Is Medicine movement.

To address the epidemic of nutrition-related chronic disease, we have to expand access to healthy, affordable food to those in our communities who are most vulnerable. Proving the food is medicine concept—and being able to measure potential cost savings to health care, whether public or private—is a key strategy for doing this. We’re proud to be leaders in this work in California and across the country.

Along with what I’ve mentioned above, we are working with CCOF to develop a policy platform and support for expanding organic agriculture in California. We’ll also be presenting a workshop at The Root Cause Coalition Conference on the importance of establishing food quality standards for food as medicine interventions that include an environmental health lens.

DS: How do you see the relationship between Ceres and ACLM evolving in the future? How can the 2 organizations help one another?

CC: We would be excited to work with ACLM and I think there are a number of mutually beneficial opportunities. We would love—along with our partners in the Food Is Medicine and California Food Is Medicine coalitions—to brief members of ACLM about the California pilot and the growing body of research around medically tailored meals, and explore how ACLM and its members can partner with us to grow support through health care providers and insurers for this intervention. Ceres delivers 110 000 hundred percent organic medically tailored meals annually that are prepared with love by the community. We are interested in supporting research about medically tailored meals in particular and 100% organic meals specifically, as well as the power of community-based organizations to provide these kinds of interventions. If there are ACLM members interested in pilot studies around organic food, pairing medically tailored meals with Diabetes Wellness Education, the potential of food to strengthen social connections, other lifestyle medicine approaches, we would love to talk.