This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

According to the state of Michigan's estimates, 1.9 million Michiganders experienced food insecurity during the beginning of the COVID-19 pandemic in 2020; 552,000 of them were children. In response, Gov. Gretchen Whitmer launched the Food Security Council in August 2020. The council issued its final report in February 2022, with 11 recommendations that seek to ensure Michigan families have access to affordable, nutritious food. 
Phil Knight.
"Food security permeates every aspect of our society. Education, health, and workforce. They are all tied together," says Dr. Phil Knight, Food Security Council chair and executive director of the Food Bank Council of Michigan. "In Michigan, we say that third grade students should read at third grade level by third grade, which is a great indicator of graduation rates. If kids are not having access to healthy food, they will never have the opportunity to learn and read at that level and develop into who they could be. If we want a really sharp workforce in 10 to 15 years, we should make sure kids have food now."

The report's recommendations were created by consensus among Food Security Council members, who represent the government, business, health, agriculture, and nonprofit sectors. The 11 recommendations cite the need for funding more fresh food through local and regional programs; getting feedback from Michiganders using community food programs; and helping Medicaid beneficiaries access foods that address their food-related illnesses, like diabetes or heart disease. Knight mentions programs like Grace Health Fresh Food Pharmacy in Battle Creek and Henry’s Groceries at Henry Ford in Detroit as two examples of how doctors can prescribe healthy food along with medicine.

"When people have access to healthy, nutritious food, it drives health care costs down," Knight says. "... This is no longer charity. It's medicine. How uplifting that is for the doctor to say, ‘This food we're giving you is important. It's part of your treatment plan. It's going to help the medicine work best for you.'"

To expand food-as-medicine programming, the council also recommends developing infrastructure for screenings, medical coding, and referrals that would unburden overextended health care providers.
Lewis Roubal.
"When there is indication of risk of food insecurity, can our system pick that up without it being labor intensive for the medical community?" says Lewis Roubal, chief deputy director for opportunity at the Michigan Department of Health and Human Services (MDHHS). "Could we connect those individuals with either a benefit program or the emergency food network in a manner that is less administratively challenging for the health care providers?"

As COVID gave rise to increasing numbers of Michiganders accessing emergency food at pantries and school pickups, the benefits of including more fresh produce, sourcing from local farms, and offering culturally appropriate foods became even more clear. Sourcing locally not only eliminates global supply chain issues but also boosts local economies and, according to Knight, creates opportunities to build equity for farmers of color.

"We are the melting pot, right? All of us eat a little different. The reason we talk about culturally appropriate food is because we want the food to be consumed," he says. "We can go to all the trouble of getting the food, sorting the food, storing the food, distributing the food, making sure that it's all safe. But if people don't eat it, it's just more expensive waste."

The Food Security Council also recognized the need to address other social determinants of health (SDOH) that exacerbate food insecurity, like lack of transportation, high housing costs, unemployment, and barriers to education. Pursuing funding through the federal Medicaid 1115 waiver could support pilot programs addressing these.

"We know social determinants of health have a very big input around healthy food access. The council had thought that the 1115 waiver might be a way to help fund some of the infrastructure that would be needed," Roubal says. "The larger issue is the awareness around SDOH and the need to access healthy foods."

Another recommendation asks for enhancements to the MI Bridges website to make access easier, creating more of a one-stop-shop for people applying for food assistance, health insurance, and other assistance. Unlike in many other states, MI Bridges and other state agency websites are not easily accessed by residents who do not speak English.

"A number of community resources and food-specific resources are available to low-income residents and neighbors across the state," Roubal says. "The reality is access to that resource is not always known. We feel that there are additional opportunities to expand upon the MI Bridges platform to help with referrals to other community agencies."
Joshua Rivera.
"So many families found themselves suddenly unemployed during the pandemic," adds Joshua Rivera, policy director at the MDHHS Economic Stability Administration. "So, if someone goes [to the MI Bridges website, it would be better if] they don't have to go somewhere else to access resources or navigate different bureaucracies and have different account logins for different sites."

In examining key causes of food insecurity, council members were surprised to discover the huge role that lack of transportation plays. Families may choose to fix a car to get to work instead of buying nutritious food. People without cars have a tough time getting to grocery stores or food pantries using public transportation. And most rural Michigan communities do not have public transportation. Knight believes emergency food needs to be available in convenient places for those who need it — at their doctor’s office, their children’s school, or delivered to their own door. Food Security Council member Diana Marin, supervising attorney with the Michigan Immigrant Rights Center, agrees. 

"Many Michigan residents cannot access food and other resources because of a lack of reliable transportation. That's number one," Marin says. "Number two, in 2008, the Michigan Legislature did something that actually made it harder for low-income children and families, in particular immigrant families, to access food, because they took away the ability for individuals without work authorization or without immigration status to be able to obtain a driver's license. Before 2008, Michigan residents were able to obtain a driver's license, regardless of where they came from and what documentation they had."

The Food Security Council is recommending driver's licenses for all. Another recommendation, expanding childhood nutrition programs and Community Eligibility Provisions in Michigan school districts, will help feed farmworkers’ children and all children facing food insecurity.
Diana Marin.
"We want to protect and nourish children. We want children to have regular healthy meals so that they can grow and do their best in school and in their community," Marin says. "The Community Eligibility Provision is a way to serve universal, free breakfast and lunch to all students in areas with high poverty rates. It reduces application barriers and stigma so that every child is going to receive the food and nutrition that they need to thrive."

Although the report's recommendations address many major food insecurity challenges in the state, they're not comprehensive. As an advocate for farmworkers, Marin was disappointed that no recommendations were made to address their low wages, work conditions, and inadequate housing, all of which contribute to food insecurity. Roubal notes that food insecurity is "an incredibly complex problem" and the solution to it "isn't easy." However, he says the council has "certainly been beneficial and really important for Michigan."

"The broad base of participation across public, private, and governmental sectors, these different perspectives, allowed us to have a deeper understanding of the issue, the interrelatedness," he says. "As a result, the 11 recommendations that were presented are strong recommendations that have a lot of potential to help us out with an issue that's near and dear to pretty much every Michigander, whether you're food insecure or not."  
 
Estelle Slootmaker is a working writer focusing on journalism, book editing, communications, poetry, and children's books. You can contact her at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Diana Marin photos by Doug Coombe. All other photos courtesy of the subjects.