Utilization of Community Benefits to Improve Healthy Food Access in Massachusetts

The Affordable Care Act increased requirements for tax-exempt hospitals. The new IRS rule governing these facilities states that they “…need to prevent illness, to ensure adequate nutrition, or to address social, behavioral, and environmental factors that influence health in the community.” This shift to community-based health creates an opportunity for hospitals to engage in the development of healthy food environments to prevent chronic diet-related diseases.

methods:  Fiscal year (FY) 2013 community benefit reports were reviewed for all Massachusetts hospitals in order to identify all healthy food access activities.  Eleven hospitals were then selected for interviews and program analysis. This included incorporation of food access in community health needs assessments (CHNAs), program implementation, and evaluation strategies.

results: All interview hospitals identified diet-related disease as a primary health challenge; however there was limited incorporation of the community food environment in their CHNAs.  State-wide 80 healthy food access activities were reported, including direct food access strategies, education programs, policy and systems oriented activities, diet and exercise interventions, and grant making activities.  Evaluation of these programs was largely focused on operational measures with few outcome indicators.

conclusion: To develop more impactful programs it is recommended that hospitals include a detailed assessment of the food environment in their CHNAs.  Further, hospitals are encouraged to focus on programs that impact systems and the environment, rather than individual behavior. Lastly, to better understand the impact of food access programs on food security and diet hospitals should incorporate more outcome indicators into their program evaluations.