SF Groups Behind Push for Healthy Food as Health-Care Benefit

Originally published by the San Francisco Examiner on April 10, 2024, by Natalia Gurevich.

A consortium of San Francisco health officials and nonprofits is pushing for California legislators to permanently enshrine access to nutritious food as a covered benefit under the state’s Medicaid program.

The California State Assembly Committee on Health will consider Assembly Bill 1975 in a hearing next week. The legislation, sponsored by the San Francisco-based Food as Medicine Collaborative and introduced by Oakland Assemblymember Mia Bonta, would make a pilot program that provides “medically supportive food and nutrition services” — including meals — a permanent benefit for Medi-Cal recipients.

If passed, the program would become permanent starting in 2026.

Founded in 2015, the Food as Medicine Collaborative seeks to bridge nutritional gaps for The City’s low-income and minority communities. The coalition now represents dozens of community clinics, food nonprofits, businesses and health-care systems in San Francisco, aiming to improve nutritional-food access and affordability.

Medical and health professionals have increasingly pushed the concept of “food as medicine,” or the notion that nutrition and diet play a significant role in managing, treating and preventing chronic health issues. The concept is especially important in The City, where a survey last year found that 30% of households with children struggled with food insecurity, meaning they lacked access to enough food to meet their nutritional needs.

Fifty-seven percent of Medi-Cal recipients were food-insecure, as were 77% of Black families.

These issues can lead to chronic health problems, including hypertension, heart disease and diabetes. A recent study by UCSF found that Latino children were more likely to develop fatty liver disease in food-insecure households. These challenges are compounded by the high cost of living and increasing wealth gaps in The City, which many local organizations part of the collaborative aim to fix.

“Here in San Francisco, one of the largest issues that we face is the affordability,” said Katie Ettman, the food and agriculture senior policy manager for the San Francisco Bay Area Planning and Urban Research Association, a local nonprofit public-policy think tank that is a member of the Food as Medicine Collaborative.

“Rent eats first — You can’t look at your landlord and go ‘Yeah, I’m just going to be $50 or $100 short this month,’” Ettman said. “But you can go to the grocery store and make a different choice to save a couple of bucks.”

Enrollees in the San Francisco Health Plan, The City’s Medi-Cal provider, can currently receive the nutritional food benefits that Bonta’s bill seeks to make permanent. Cissie Bonini, the executive director of EatSF, said this allows Medi-Cal patients to receive guidance from their own physicians, which might not be as personalized in other settings.

“It’s a huge difference to be able to have your food-security intervention happen in the clinic or have it come from having that conversation with your doctor,” she said.

EatSF was founded the same year as the Food as Medicine Collaborative, of which it is a member. The organization and the coalition have received funding from the Hellman Foundation, which last year pledged $20 million over the next five years to the collaborative and other similar programs in The City.

During that time, foundation senior director Pedro Arista said it intends “to expand the clinic infrastructure to increase access to healthy and nutritious food.” Bonta’s bill is a piece of that strategy, he said, as is increasing collaboration between community clinics and nonprofits that want to widen access to healthy and nutritious food to a greater number of people.

“Our role really is to listen, to learn, to also provide partnership where helpful,” he said. “We also provide a number of capacity-building resources to aid them in their impact and their ability to do the important work that they do in the city and county of San Francisco.”

The cost of food remains a challenge for the foundation, the collaborative and other organizations in the space — but so does access.

In the last year, a Whole Foods on Market Street near Civic Center closed its doors, and the Fillmore Safeway — the only full-service grocery store in the neighborhood — is set to close in 2025. The store was originally going to close last month, but city officials struck a deal to push it back following community outcry.

San Francisco Supervisor Dean Preston, whose district includes the Fillmore, introduced an ordinance last week that would require grocery stores in The City to provide six months’ notice before closing, meet with community members prior to shutting their doors and explore options to open replacement stores.

The Neighborhood Grocery Protection Act is a revival of the Supermarket Closure Ordinance, which the Board of Supervisors approved after the 1984 closure of a Safeway at Bush and Larkin Streets. Then-Mayor Dianne Feinstein ultimately vetoed the measure.

“It was a good idea in 1984, and it’s an even better idea now,” Preston said in a statement. “Our communities need notice, an opportunity to be heard, and a transition plan when major neighborhood grocery stores plan to shut their doors. Meeting the food security needs of our seniors and families cannot be left to unilateral backroom decisions by massive corporate entities.”

Ettman said the state and local progress is encouraging, especially since many nutritional food programs have long been funded through philanthropy and, as a result, have had short shelf lives.

She said that wouldn’t be the case for efforts such as AB 1975.

If the food-access pilot becomes a permanent Medi-Cal benefit, “We will see the long-term health impacts because you won’t be stopping and starting programs an individual can really benefit from,” she said.