Cultivating Total Health: Implementation of the Clinic-to-Community Integration Strategy to Intervene on Food Insecurity

Abstract

The United States (U.S.) is the country with the highest per-capita spending on healthcare services, but ranks near the bottom among peer countries for social services spending. This underinvestment in social services has been theorized to be a factor for why the U.S. healthcare system ranks among the bottom on access, quality, and population health outcome indicators. While improvements in medical care quality could prevent 10-15% of premature deaths, the remaining root causes include genetics, and the social, economic, and environmental determinants of health. Policy and program interventions to improve social and economic disadvantage, reduce poor social behaviors, and enhance built environments, could reduce population health inequities and improve health status overall. Yet, healthcare systems do not yet know how to translate this research evidence into effective and equitable interventions to improve population health and reduce health inequities. Stronger evidence of intervention effectiveness is needed, with accompanying implementation and dissemination research, to guide decision-making and secure funding for social determinants of health interventions in clinical settings. This DELTA Project fills a gap in the literature by providing an in-depth, qualitative case study on the implementation of a Clinic-to-Community (CCI) integration strategy to intervene on one specific socio-economic determinant: food insecurity. In Part 1: Analytical Platform, I first provide a brief overview of the U.S. healthcare system performance and social determinants of health drivers contributing to poor healthcare access and status. Second, I conduct a comprehensive assessment of food insecurity, including definitions, burden, risk factors, and associated health outcomes. Third, I provide a review of government policies and healthcare system programs to address food insecurity. Finally, I introduce the program design for the CalFresh Enabled Enrollment Pilot Program, with special focus on the theoretical framework and implementation strategy. In Part 2: Results Statement, I utilize the descriptive case study methodology to assess the DELTA residency along the following stages: on-boarding months, planning months, and implementation months. In the concluding section, I articulate key learnings, including critical reflections on the original project theory and strategy, and discuss future directions.