Background

More Americans are sick than healthy, with nutrition-related illnesses such as obesity, diabetes and heart diseases playing a major role. Meanwhile, one in ten families in Durham reported skipping meals because they didn’t have enough money to buy food, with drastic rate increases for minority communities. 

The Biden Administration held its first White House Conference on Hunger, Nutrition and Health in September 2022 to develop strategies to end hunger by increasing healthy eating and decreasing diet-related diseases by 2030. In the past year, 160 billion federal dollars were invested into the United States Department of Agriculture’s Food and Nutrition Services efforts, including its flagship Supplemental Nutrition Assistance Program (SNAP), Women, Infants and Children (WIC) food assistance program, and school lunch programs. 

In North Carolina, these goals have led to $650 million in Medicaid funding for the state’s new Healthy Opportunities Pilots to test and evaluate evidence-based, nonmedical interventions related to food and other social determinants of health. Despite these investments, North Carolina’s SNAP-eligible resident enrollment is only 69%. 

Meanwhile, the charitable food sector has played a significant role in on-the-ground service. But the extent and challenges of integrating grassroots interventions and services — especially with underrepresented minorities and undocumented people — are currently unknown, as are the ways in which efforts from for-profit and local agricultural sectors contribute to filling these gaps.

Project Description

This project team will support ongoing community-derived goals for the coordination of Durham’s food security organizations. Team members will collect novel data and insights regarding federal program utilization to effectively coordinate efforts among nonprofit, local government, faith-based and medical partners.

The team will operate under two complementary subgroups. One subgroup will focus on understanding the perspectives of community members and entities on how food and nutrition policies are implemented. Team members will look into how Durham and Duke entities have addressed food and nutrition security and broader social determinants of health, as well as these entities’ relationship to federal and state policies. They will seek to understand and compare community-based and engagement programs in Durham, including Root Causes’ Fresh Produce Program and Duke’s Benefits Enrollment Center, trace the motivation and support of these programs, and ascertain willingness and barriers toward federal integration to address hunger and nutrition in Durham. 

This analysis will occur through interviews and surveys with approximately 250 Root Causes participants, as well as representative members of other programs. The team will prioritize investigating the extent of inclusion of historically excluded populations in federal, state and local programs.

The second subgroup will focus on gaining a greater understanding of policies surrounding food and nutrition security and social support programs regarding social determinants of health at the federal, state and local level. Working closely with Duke’s World Food Policy Center, Department of Population Health Sciences, the Margolis Center for Health Policy and other campus and off-campus sites, team members will consider public and health-oriented policy. They will focus primarily on the Department of Agriculture’s Food and Nutrition Services programs and the potential integration of food-related benefits into Medicaid and health maintenance organizations. 

Through literature reviews, site visits to policy-related centers at Duke and Durham, and interviews, team members will prioritize evaluating racial equity in service implementation and investigate the extent to which policies demonstrate innovative and effective methods improving health outcomes of historically excluded populations.

Anticipated Outputs

Literature reviews; qualitative data regarding experiences and perceptions of hunger relief programs; public scholarship on health equity and inclusion for federal, state, and local food and nutrition security programs and other programs addressing social determinants of health; dissemination of findings to public and private sector stakeholders

Student Opportunities

Ideally, this team will include 3 graduate and 7 undergraduate students. Students from a variety of academic and personal backgrounds with interests in food and nutrition policy, program implementation and intersectional health equity are encouraged to apply. Applicants should be interested in subjects such as social determinants of health, economics, law, policy, charity and faith-based organizations, social science research and food systems. Students with Spanish, Dari or Pashto language fluency are especially encouraged to apply. 

This project will offer students a way to hone their skills in qualitative and quantitative data collection and analysis. Team members will have opportunities for policy scholarship and/or brief writing with the potential opportunity to present this work at conferences and meetings with university, county and state bodies relevant to food security policy and program implementation. 

Team members will be integrated into Root Causes during the duration of this project, including placing phone calls to Durham community members with delivery confirmations and data collection instruments as well as direct community contact if assisting in the program’s product packing and delivery on Saturday mornings. Those comfortable with Spanish and other languages used by members of the community will have the opportunity to communicate in these languages, strengthening language capabilities.

Some students will travel to Kansas City, Missouri to the Root Cause Coalition’s 8th Annual National Summit, a conference centered on social determinants of health, health equity and health policy.

Elaijah Lapay will serve as project manager.

In Fall 2023, this team will meet on Tuesdays from 3:30-4:45 p.m.

Timing

Fall 2023 – Spring 2024

• Fall 2023: Develop team charter; complete HIPAA, Duke Collaborative Institutional Training Initiative and data management trainings; complete Institutional Review Board submissions; integrate into weekly workflow of Root Causes Fresh Produce Program; assemble literature reviews; plan and begin stakeholder interviews; begin survey/data collection for current recipients
• Spring 2024: Complete stakeholder interviews and surveys; identify and implement team-wide community-based project to address barriers identified by data; disseminate findings through stakeholder meetings, policy brief/academic writing, community events, etc.

Crediting

Academic credit available for fall and spring semesters

See related team, Improving Food Security to Increase Resiliency to COVID-19 for Latinx Populations (2020-2021).

Image: Leafy greens, by Kandukuru Nagarjun, licensed under CC BY 2.0