Food is a healer, and it builds resilience. Both of these qualities are absent in populations who live with food insecurity and the malnutrition that comes from consumption of unhealthy food products. The proposal by the Michigan Department of Health and Human Services to fund evidence-based nutrition programs deserves to be implemented for the best interests of patients we serve in our primary care practices, as well as the broader population in urban Detroit who are afflicted with chronic diseases like hypertension and diabetes, which are related to poor and inadequate diets.
Authority Health offers primary care services at four sites, serving a predominantly Medicaid population. Our patients range in age from infancy through old age. Food insecurity is documented among a large number of these patients.
We applaud the progressive program enhancement represented in this offering and look forward to its implementation. Without question, the proposed “in lieu of services to cover nutrition services” will result in improved health and reduce the future need for medical services beyond primary care. As noted below, we recommend clinical guidance with food products so as to maximize their utility and sustainable dietary practices.
Specific programmatic comments:
Loretta V. Bush, MHSA
President and CEO
Authority Health
313-871-3751
]]>At a recent healthy food preparation demonstration at our Ruby Cole Community Kitchen, Charles Jackson, Jr., an MSU Extension nutrition instructor, gave a simple but thoughtful explanation of why fresh food “from the soil” is better than processed food. Fresh food is prepared by people who know you and love you. Processed food is prepared by people who don’t know you or love you.
Poet Crystal Wilkinson, in her book Praisesong for the Kitchen Ghosts, offers a lyrical perspective: “I eat for taste. I eat to remember. Food is a conduit to the past. I am thinking of healing. I am thinking of this notion of eating what the body craves come spring, a communal memory housed in the cells. Healing.”
In this land of plenty, children need to be fed in school, not just at lunch, but at breakfast. And not just during the school year. There is hunger in American in a culture that also is plagued with obesity. The disease of overconsumption is also a disease of malnutrition. And too many folks move from food deserts to food swamps, unable to find something good to eat at an affordable price.
Preparing fresh food not only provides nutrition, but also can offer a setting for conversation around health and well-being. Amanda Dawnrich, as an Albert Schweitzer Fellow at Authority Health, demonstrated that women — returning citizens — could find common ground through demonstrations of healthy cooking at Heartline in Detroit.
As the concept of “food as medicine” makes its way into mainstream health system programming, it needs to hit main street where the most vulnerable people live. Initiatives like the Detroit Great Grocer Project, developed by the Detroit Food Policy Council, provide a foundational step toward promoting healthy food in stores and markets where they already are going to and not getting fresh produce or healthy “grab and go” food products. Authority Health demonstrated through a State of Michigan pilot program a few years ago that you can sell healthy grab and go products in gas stations and convenience stores.
This year, through a state grant, Authority Health will launch the Healthy and Resilient Community initiative, designed to expand access to healthy grab and go foods, as well as promote nutrition and healthy eating at the neighborhood level. Good food sustains healthy people and provides resilience to withstand the next health challenge — whether it be a community disease outbreak or a personal illness or injury. The challenge is to meet people where they are with what they need and encourage them to want it.
As Jackson pointed out, we need to bring more love into the homes of people through good, healthy food. In the coming months, Authority Health will be doing just that, with the help of our community partners.
]]>When Dr. Alyssa Motzel was looking for a pediatric residency program, she wanted an experience in which she would treat all children. Through her training at Authority Health in Detroit, “I’m seeing the world of medicine, not just a pocket of medicine.” Literally.
Earlier in 2023, Dr. Motzel, together with recently-graduated Authority Health resident Dr. Sarah Harris-Kober and residents from Vanderbilt and Georgetown universities, completed a six-week clinical rotation in Mutomo, Kenya, through the Catholic Medical Mission Board. While medical care is a constant aspect of the experience, Dr. Motzel and her colleagues were there to teach and create a sustainable value for Kenyan clinicians. She provided three lectures per week, taught operating room procedures, provided laboratory training, and worked in the orthopedic, HIV, and tuberculosis clinics. She also participated in cancer support groups and went on field service trips throughout the country with Red Cross and UNICEF, helping provide vaccines and support for a measles outbreak.
Dr. Motzel experienced the “challenges and possibilities of caring for people with medical problems complicated by the social determinants of health.” Her challenge was similar to that working with children living in high-poverty areas of Detroit, except exponentially every social determinant was complex, from food and housing insecurity to transportation. These exacerbated the medical problems she faced.
She knew about the importance of understanding the circumstances that affected someone from becoming healthy, but “I didn’t understand the gravity” of how it applied to the impoverished region of Kenya. “Everything I learned at Authority health really matters. This is meeting people where they are.”
In addition to their clinical residency requirements, Authority Health residents complete special training in population health, trauma informed care, and antiracism/social justice.
An essential lesson learned through the Kenyan experience was the importance to lead with humility, Dr. Motzel says. “That is important when going into an unfamiliar community. It doesn’t have anything to do with medicine or patient care. I’ve found that making a true relationship with people – outside of being a doctor – to being a visitor, being part of their lives and being interested in their lives matters. You have to get to know them as people instead of subjects you’re trying to help. You’re a guest in their lives.”
Her indoctrination to the complexity of this clinical rotation “came fast and furious,” she says. “As soon as I walked into the hospital on the first day I realized: no windows, no doors. Everything is open to the outside. My first conversation was with a patient whose child had been sick for a month.” They couldn’t get to a physician any sooner. Her patients presented a variety of health problems compromised by abject rural poverty.
Dr. Motzel did considerable work in acute health care settings, treating over 400 children, as well as providing 100 hours of community service and education for nurses and physicians. In addition to testing her ability to analyze the impact of social determinants, her Kenyan rotation enhanced her residency training by learning to provide medical care with few resources, becoming sensitized to community dynamics affecting the health of her patients, and making worldwide health connections and extending the mission and work of Authority Health.
Global health has been part of her passion for a long time. During her undergraduate years, she participated in a mission trip to Nicaragua. She was looking for a residency training opportunity that offered an experience in global health. When she heard that Authority Health offered the medical mission to Kenya she was even more excited about selecting this training site.
“I wanted to go. I knew it was going to be a transformative opportunity to go to a community that was out of the comfort zone that I was used to, pushing me to the limit… If I can learn how to practice medicine in a very low resource area place like Mutomo, Kenya, when I came back to Detroit, I’d be that much better of a physician.”
Upon her return, Dr. Motzel has provided formal and informal insight on the Kenyan experience to her fellow residents. “I’m a senior resident now. From that experience, I’m able to teach from that perspective, to empower them to think about (medical care) in different ways.” For example, she is far more acutely aware of the appropriate use of resources – financial and material – after working in an environment of relative scarcity.
The next step in Dr. Motzel’s career is pursuing a fellowship in endocrinology. As with Authority Health, she is looking for a fellowship program that will allow her to do global health work in addition to her fellowship responsibilities. She feels that the Kenyan experience has confirmed her lifetime goal of pursuing medical missions abroad with her husband, who is completing an orthopedic residency.
Dr. Motzel and Dr. Chaya Pittman-Hunt, director of the Authority Health Pediatric Residency Program, presented the Kenyan rotation to the Authority Health GME Teaching Health Center Board of Directors in November. “We are creating an experience for residents that is more longitudinal,” Dr. Hunt explained. Spending several weeks in a region not only offers more extensive training, but it also gives a greater opportunity for the resident to provide patient care to Kenyans and train Kenyans who seek training in the field of healthcare or medicine.
Loretta Bush, president and CEO of Authority Health, noted that Dr. Motzel embodies the spirit of the Authority Health mission. “You represent the heart of Authority Health,” she said. “Many times, the administrative staff doesn’t have a chance to interact with residents and are hopeful that they understand the mission and vision of Authority Health. You represented it beautifully. It’s in your DNA.
“The patients you will touch and the communities you will touch will be better for your experience. You get it. I’m confident that you will carry this with you. I look forward to how you are going to change lives in the future.”
An intense experience like the Kenyan rotation often has a significant impact on the character and career development of physicians. For Dr. Motzel, it was a reminder that she may have specialized in pediatrics; she is first and foremost, a physician.
“In the U.S., everyone is hung up on specialties,” she says. “Being in Kenya made me a better physician because it reminded me to be a doctor. It doesn’t matter where you went to school, you’re showing up for work and you’re a doctor trying to help patients. It changed me to remember that no matter where I’m at, I’m a physician first. I will take that wherever I go.”
]]>It’s distressing to learn from practicing physicians that racism and sexism continues to create a toxic work environment for professionals. A recent LinkedIn post involving the career choice of Uche Blackstock brought this festering problem to the fore. Dr. Blackstock, an emergency physician resigned her academic post to establish a consulting agency, Advancing Health Equity, focused on racial equity in the workforce and improved health care and community health promotion for people of color. Despite decades of progress in cultivating health professionals of color and promoting pipeline programs to help students prepare for rigorous health professional careers, the problems of racism and sexism persist.
Dr. Blackstock’s consulting is focused on training more Black physicians, but she says “We need physicians who are not Black to be able to adequately and competently care for Black people as well.”
Authority Health, which promotes an overall institutional commitment to health equity, has refined its curriculum in antiracism and social justice for its medical residents. Coupled with our extracurricular programs in population health and trauma informed care, our residency training responding to the needs identified by Dr. Blackstock and others.
The Anti-Racism and Social Justice curriculum emerged through resident request as a response to the police murders and brutality evidenced in 2020. The program, beginning in the first quarter of 2024, will incorporate the values and content originally proposed by the residents, along with a fresh approach to the three years of training as listed below. I am excited by continuing our relationship with New Detroit as our programmatic partner.
The new format, beginning in the first quarter of 2024, offers guest presenters to augment ongoing program staff. This program was designed in partnership with New Detroit. Each year will offer our primary care medical residents differing points of emphasis. We believe our residents will be uniquely prepared for providing medical care in underserved areas of our nation, urban or rural.
For information on this program, contact Angela Cole, Designated Information Officer for the Authority Health Teaching Health Center: acole@authorityhealth.org.
Dennis Archambault is vice president of Public Affairs for Authority Health.
]]>By Dennis Archambault
Credit Groundwork Center for Resilient Communities in Traverse City for fostering the vision and advocacy to create a healthier environment based in the preservation and distribution of locally grown food. Authority Health and the MOTION Coalition supported its “10 Cents a Meal” program, which began as a way of incentivizing school systems to purchase Michigan produce. Schools receive financial support from the state to buy locally sourced produce: a win-win for child nutrition and the farm economy. In urban Detroit, where small-scale growers are struggling to achieve sustainability, this offered an additional market for their goods.
The nearly 30-year legacy of Groundwork, featured in a book entitled, Shared Abundance, inspired the Michigan Department of Agriculture and Rural Development to create a “Farm to Family” program. Gov. Whitmer has proposed $4 million in the fiscal 2025-26 budget to fund this initiative which will “support regenerative farming, agriculture supply chains, and promote Michigan food products in the home through a cooperative, which will generate direct economic impacts,” according to Tim Boring, MDARD Director. The goal, he says, is to use this program to create a food economy in Michigan that can give consumers better access to Michigan-grown and Michigan-made products. “We want to be making sure that in underserved communities across Michigan – rural areas or urban areas – we’re getting Michigan food on family plates in a way that feeds families,” Boring says. “We see that as an investment in our long-term future healthcare costs in the country. And of course, we also see it as a way to drive demand for food products that are made here in Michigan.”
The state is already encouraging Michigan families to purchase shares in locally offered Community Supported Agriculture (CSA) services through a 75 percent financial incentive. The Michigan Fitness Foundation is the intermediary for this aspect of the Farm to Family, which is operating in eight Michigan communities. In Detroit, Deeply Rooted Produce and Eastern Market are affiliated with this program.
Dennis Archambault is vice president of Public Affairs at Authority Health.
]]>By Dennis Archambault
Pandemics, like wars and other catastrophic experiences, offer lessons that, when realized and learned, can improve the human condition. One of the lessons learned during the COVID-19 pandemic is the importance of the primary care provider in collaborating with public health officials to mitigate the effects of the disease outbreak. Primary care practices, such as Authority Health’s Popoff Family Health Center, are embedded in neighborhoods and connected to community through individual patients and community stakeholders. They assume additional risk to provide care, screenings, vaccines, and other community engagement and education. And during the lockdown and varying degrees of isolation that followed, telehealth capabilities came of their own in short-distance urban settings.
Michigan writers, in an article published in winter The Millbank Quarterly, argue that fostering greater collaboration between public health and primary care through the Affordable Care Act’s Prevention and Public Health Fund, is a sensible way to advance community health. “Primary care emerged as central to public health’s pandemic mitigation strategies,” the authors contend. “Under very difficult circumstances, primary care physicians did an exemplary job in treating COVID-19 patients and participating in vaccination campaigns.” This brought to light the core value of primary care, especially as practiced among populations most vulnerable to the pandemic. “A key lesson from COVID-19 is that expanding the scope of primary care to include population health better aligns medical care and public health to improve health outcomes.”
Primary car practices need financial incentives to expand beyond the public health role they currently play to increased screenings, analysis of social determinants of health, providing community education and social marketing, and addressing systemic contributors to the social determinants. The authors note that not only do primary care providers need better reimbursement, but they also need training to understand the expanded role they can and need to play in promoting population health.
That is precisely the value of teaching health centers such as Authority Health, where medical residents are based in community health centers like Popoff and gain an appreciation for the lived experiences of their patients. Additionally, they delve into population health through a required University of Michigan certification program, as well as training in trauma-informed care and antiracism/social justice.
The future of community health lies in the integration of primary care and public health – and to increase funding available to incentivize this fusion. As the writers note, “Building on the lessons learned is essential to meet the ever-increasing public health challenges facing us all.”
Marianne Udow-Phillips, Samantha Iovan, from the Center for Health & Research Transformation, and Peter D. Jacobson, retired from the faculty of the University of Michigan School of Public Health, contributed to The Millbank Quarter article. Dennis Archambault is vice president of Public Affairs for Authority Health.
]]>By Dennis Archambault
Healthy students learn better. Conversely, unhealthy students struggle to learn. Keeping kids healthy results in improved academic performance, through improved mental acuity, increased immunization rates, and reduced absenteeism. The State of Michigan, which has promoted development of school-based health centers, has designed February “School-Based Health Care Awareness Month.”
In a proclamation designating this special observance, Gov. Gretchen Whitmer noted that there are over 300 school-based and school-linked health centers and programs in the state offering primary, preventive, early intervention, and mental health service for children in all grade levels in urban, rural, and suburban schools. School-Based Health Care Awareness Month offers “a time to acknowledge the commitment and passion that school-based health center staff and parents/guardians show for all Michigan children and youth. We also recognize the critical role they play in improving the health and well-being of all Michigan children.”
Authority Health supports this endeavor by sponsoring school-based health centers at Hope Academy in Detroit and Adlai Stevenson Elementary School in Southfield. We not only provide a full array of primary care services for students in the schools, but also for young people living in the neighborhoods surrounding the school. School-Based health centers are catalysts for creating healthy communities for children to grow and learn.
Dennis Archambault is vice president of Public Affairs for Authority Health.
]]>By Dennis Archambault
As a young religious minister, Albert Schweitzer told his congregation in the early 20th century that he was leaving his church to study medicine and use that to help remedy the ills created by European colonialism, slavery, and racism. He said, “I decided to make my life my argument.” Schweitzer became a medical doctor and spent his life providing medical care in Africa. More than a century later, thousands of young health and human service professionals have made the same commitment through the Albert Schweitzer Fellowship, hosted in Detroit by Authority Health.
Historian Heather Cox Richardson would consider Schweitzer Fellowship projects an example of common heroism. Reflecting on Dr. Martin Luther King, Jr.’s final speech, Richardson paraphrased Dr. King’s words: “If God had let him choose any era in which to live, he would have chosen the one in which he had landed.” Dr. King’s comments made in 1966 are eerily relevant today: “The world is all messed up. The nation is sick. Trouble is in the land; confusion all around…. But I know, somehow, that only when it is dark enough, can you see the stars.” He denied any aspiration to greatness, only that he had been called to act.
Detroit Schweitzer Fellows Claire Hawthorne and Asiimwe Najjuma chose to serve about 25 meals for parents of seriously ill and injured children hospitalized in Detroit and staying at the Ronald McDonald House. This service project, commemorating the Day of Service honoring Dr. King’s legacy, offered them an opportunity to reflect on how and why to serve people. In a broader sense, this was about the ethic of service as espoused by Dr. King and Dr. Schweitzer.
Dr. King had much to say about the importance of service. But he summarized it in this quote: “Life’s most persistent and urgent question is: “What are you doing for others?” Dr. Schweitzer, in a more didactic manner, said “The purpose of human life is to serve and to show compassion and the will to help others.”
No doubt, the Schweitzer Fellows didn’t think of themselves as heroes as they prepared chicken, potatoes, and green beans on an evening at the Ronald McDonald House. It was a symbolic, though intentional act that highlighted a year of service – over 200 hours’ worth – which is their way of defining the argument of their life: to live a life that values service above self-interest and beyond what society expects.
Dennis Archambault is vice president of Public Affairs for Authority Health.
]]>By Dennis Archambault
The World Health Organization believes a healthy community is not defined merely by health status. It is a process of improving health. The “built environment” or structural design plays a key role in that, and architects are the ones primarily involved in designing what is built.
Healthy community advocates should be delighted that Kimberly Dowdell has been elected president of the American Institute of Architects. Dowdell has a pronounced view of the role that architects can play in creating healthy, equitable cities. Architects, she says, are “civic problem-solvers.” She believes that cities should “focus more on climate action, affordable housing, and health equity. And I believe that architects are uniquely well-equipped to support mayors in these areas.”
Dowdell is a native Detroiter who spent her formative years living and observing her city. It’s significant that as a child she realized the psychological effect of blight on the health and well-being of people exposed to it day-in, day-out. “Hudson’s was boarded-up and was looking very sad. And the people around the building were looking sad. I was thinking: ‘I would like to fix this building.’ I felt if I could do that, I could heal the people around it. And that’s when I went from wanting to be a doctor to wanting to become an architect.”
Arguably, it isn’t that Dowdell lost her interest in healing and adopted urban design. She transformed her passion for health to becoming a doctor of urban design and built structures.
In its platform statement on “What is a healthy community,” the World Health Organization says a healthy community fosters an “accessible social, physical and cultural” environment.
A healthy city creates an “accessible social, physical and cultural environment that facilitates the pursuit of health and well-being.” That includes integrating health equity and sustainability into urban development and planning. This has been central to the philosophy of the Detroit Collaborative Design Center at the University of Detroit Mercy.
With Kimberly Dowdell’s leadership and advocacy at the national level perhaps more architects will focus on how to design healthier communities as much as they focus on how they design interesting buildings.
Dennis Archambault is vice president of Public Affairs for Authority Health.
]]>By Dennis Archambault
I discovered the art and science of soup years ago when I was first experimenting with serious cooking on a low budget. As I wrote in a previous blog, I learned about the health benefits of a rich broth from the late Matt Prentice, who was hired by Henry Ford West Bloomfield to develop healthy, tasty entrees for the then new hospital. Prentice believed that food is indeed medicine. The “healing” comes in when a recipe incorporates vegetables and herbs that provide excess minerals and vitamins – “intensely.” For example, many of Prentice’s recipes incorporated broccoli sprouts, which have a high concentration of the antioxidant sulforaphane, into sandwiches and salads. Sulforaphane is believed to prevent and fight cancer, plus, Prentice added, broccoli sprouts are delicious. He applied this thinking to all of the recipes. To support the recipes, Prentice wrote a 48-page manual, The Health and Illness Prevention Aspects of Food, for the Henry Ford food service staff.
Who has time for slow cooking today, you might ask. Well, Bethany Thayer, a Henry Ford Health dietitian and food writer, promoted the merits of using a slow cooker for minestrone soup in a recent Detroit Free Press column. She led with a quote from the classic French culinary expert, Auguste Escoffier: “Soup puts the heart at ease, calms down the violence of hunger, eliminates the tension of the day, and awakens and refines the appetite.” Even in an era of buttery sauces, fatty meats, and rich sweets, Escoffier knew there was holistic goodness in a soup. Something to consider with the arrival of winter.
Thayer, who has provided Free Press readers with many tasty and healthy recipes through the years, elevates soup, specifically the Italian vegetable soup, “minestrone,” to the upper echelon of “food is medicine” hierarchy. She offers a five-point argument in support of this:
For more information on this and other topics relating to cooking an nutrition, visit henry-ford.com/blog, or contact Thayer at HenryFordLiveWell@hfhs.org.
Dennis Archambault is vice president of Public Affairs at Authority Health.
]]>By Dennis Archambault
As we have seen with Medicaid redetermination, the administrative process is responsible for a majority of failed redetermination efforts. Navigation is key to maintaining Medicaid coverage, as well as other social services. A national advocacy group says the same is true for Supplemental Nutrition Assistance Program (SNAP).
Currently, the SNAP application process, which requires an interview with the client, must take place within 30 days. When SNAP was established in 1978, the Agriculture Department kept the interview requirement inherited from the previous food stamp program, stating that the interview helps the agency understand a household’s circumstances and helps the household understand the program. It was not required when SNAP was established, however.
Advocates argue that working recipients with family responsibilities have difficulty meeting the required timeline for the interview. Less than 80 percent of those who qualify for SNAP benefits actually receive them, according to the Agriculture Department. According to a 2018 GAO Report, nearly 2 million of the approximately 3.3 million students eligible to participate in the Supplemental Nutrition Assistance Program (SNAP) do not participate, leaving about $3 billion in SNAP benefits untapped each year, the National Student Legal Defense Network has indicated.
Proponents say that during the COVID pandemic emergency, the interview process was waived, and recipients were automatically recertified. As a result, food insecurity remained controlled. However, once the emergency period expired, decertification occurred. Students, many of whom also have job and family obligations, are particularly vulnerable to not qualifying for SNAP, according to advocates.
The National Student Legal Defense Network, the Center for Law and Social Policy, and the California Student Aid Commission are among the organizations advocating for changing the SNAP interview requirement.
Dennis Archambault is Vice President of Public Affairs for Authority Health.
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By Dennis Archambault
The Centers for Medicare and Medicaid announced that 21.3 million people selected an Affordable Care Act Health Insurance Marketplace plan during the 2024 Open Enrollment Period. That’s another historic milestone for the Affordable Care Act, which was established in 2010 under President Barak Obama to help ensure access to health insurance coverage for most Americans. Total plan selections include more than five million people — about a fourth — who are new to the Marketplaces and 16 million people who renewed their coverage, according to CMS.
“These historic enrollment numbers are a testament to the need for comprehensive, quality, affordable health insurance, and we must do everything we can to protect and expand access to coverage for all people,” said CMS Administrator Chiquita Brooks-LaSure.
Proponents of the ACA worked hard to establish the law, which has faced opposition from the day the legislation was signed. In the past three years, the Biden Administration bolstered promotion of the ACA during open enrollment periods, something that has been underfunded previously. This enables more people to know about the opportunity and encourage them to enroll. Additionally, the Inflation Reduction Act (IRA) and the American Rescue Plan continue to keep Healthcare Marketplace coverage affordable. As a result of the IRA, four in five HealthCare.gov customers were able to find health care coverage for $10 or less per month for plan year 2024 after subsidies. Additional funds were made available to hire more health care navigators to work at the community level to help people enroll.
Authority Health is a certified federal Healthcare Marketplace enrollment source. For more information our navigation services, contact Tamika Withers, Medicaid Finance Manager, at TWithers@AuthorityHealth.org.
For a complete report on this year’s Healthcare Marketplace performance, go to: https://www.cms.gov/newsroom/fact-sheets/marketplace-2024-open-enrollment-period-report-final-national-snapshot
Dennis Archambault is vice president of Public Affairs for Authority Health
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