Innovating at the Intersections: A Social Entrepreneurship and Systems Approach to Promote Food Security in Greater Boston, Massachusetts

Abstract

One in nine people nationally and one in 11 adults in Massachusetts cannot afford to eat normally. While food security services and resources exist, the systems for screening, referral, and/or service provision is uncoordinated. The federal government spends over $160 billion yearly to treat food insecurity related health issues. In 2018, MassHealth created Accountable Care Organizations. Led by healthcare provider groups, these organizations aim to improve population health, enhance care quality, and lower costs. To achieve this, they screen for social determinants; contract with community-based organizations to offer services; and show results of impacts. Through the lens of social entrepreneurship and systems thinking, this thesis identified delivery and financing gaps and opportunities in promoting food security, and explored both intra- and entrepreneurial efforts, in Greater Boston. Quantitative research from the National Survey on Children’s Health showed that Massachusetts households are better resourced than US families, and US households with food insecurity face modifiable socio-economic and family stressors. Interviews with stakeholders in healthcare, social services, health insurance, and government revealed shared missions and unprecedented financial incentives to collaborate. While screening, referrals, or service provision are still fragmented, this shift is creating opportunities for community-based organizations and social ventures to partner with large healthcare entities. Beyond Massachusetts, as healthcare shifts towards population health, it will be crucial to intervene on social determinants. Short of public policy changes that target root causes of inequities, new mechanisms of action are needed. Accountable Care Organizations could reduce massive costs on healthcare and society, as well as enhance population health across the lifespan.