By James R. Elliott and Scott Frickel
Philadelphia's hip Northern Liberties community is an old working-class neighborhood that has become a model of trendy urban-chic redevelopment. Crowded with renovated row houses, bistros and boutique shops, the area is knit together by a pedestrian mall and a 2-acre community garden, park and playground space called Liberty Lands.
First-time visitors are unlikely to realize they're standing atop a reclaimed Superfund site once occupied by Burk Brothers Tannery, a large plant that employed hundreds of workers between 1855 and 1962. And even longtime residents may not know that the 1.5 square miles of densely settled land around the park contains the highest density of former manufacturing sites in Philadelphia.
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By Liza Bayless
Five years ago, when Lankenau Medical Center was confronted with evidence that it was serving the unhealthiest county in Pennsylvania, the hospital decided to embrace the findings with an unconventional approach: building a half-acre organic farm on its campus to provide fresh produce to patients.
The Deaver Wellness Farm at Lankenau Medical Center. Lankenau Medical Center
The teaching and research hospital just outside Philadelphia was in the midst of its own patient health needs assessment in 2011 when the Robert Wood Johnson Foundation released findings about health outcomes in Pennsylvania counties. Lankenau is officially located within Montgomery County, one of the state's healthiest, taking into account factors including obesity rates and access to reliable sources of food. But the campus is adjacent to and receives many patients from Philadelphia County, ranked the least healthy of all 67 counties.
"That was really telling because it showed that we were serving a really diverse patient population," said Chinwe Onyekere, associate administrator at Lankenau, of the study's revelations. The findings showed that the hospital's patients had widely varying access to healthy food and nutritional knowledge.
With more than 1.5 million people, Philadelphia is one of the largest cities in the country and consistently named one of the unhealthiest. In 2010, 32 percent of its adults and about 25 percent of its children were obese. The same year, 13 percent of the city's adults had diabetes, and Philadelphia County ranked highest among the country's largest counties for chronic illnesses like cardiovascular disease and hypertension.
Across the nation, about half of Americans are estimated to have some kind of chronic disease stemming from health risks including lack of exercise, obesity, smoking and unhealthy eating. Treatment for these illnesses, which include asthma, heart disease or diabetes, has accounted for more than 75 percent of hospital admissions and physician visits in recent years.
This has caused some hospitals to look for ways to address health needs before a patient's condition has deteriorated so much that a hospital visit is necessary. At Lankenau, that meant providing its patients with a source of healthy food.
Students learn about fresh produce at the Deaver Wellness Farm. Lankenau Medical Center
Because the doctors, nurses and other staff were not farming experts, the hospital paired with Greener Partners, a nonprofit advocate for local food systems in Pennsylvania, to build and maintain what would become the Deaver Wellness Farm. Onyekere, who heads community needs programs for the hospital, oversees the project.
Since the farm's launch in 2015, it has provided more than 4,000 pounds of organic food to hospital patients at no cost. The produce is used for educational demonstrations and served in the hospital cafeteria. From its community needs assessment, Lankenau's staff learned that many of its patients, especially from West Philadelphia, lacked access to and nutritional knowledge of fruits and vegetables. So Lankenau now facilitates pop-up markets in internal medicine and the OBGYN practice wards.
While patients wait for appointments, medical assistants bring in fresh kale, broccoli, tomatoes, eggplant, arugula and other produce for them to select. The hospital also provides recipes, and, during an appointment, physicians use the produce to show how a patient can make healthier lifestyle choices.
In the Lankenau waiting rooms, hospital employees lead nutrition courses and food demonstrations. An employee might bring in the materials for a carrot salad, discuss the nutritional significance of each of its ingredients and then chop and assemble the salad in front of patients. Afterward, patients are given the ingredients and a recipe to try at home.
A young visitor gets a taste of what we do at the #DeaverWellnessFarm at #LankenauMedicalCenter. https://t.co/jTSbIAs4B3— ilana_grubin (@ilana_grubin)1480014835.0
For years before the farm, health educators employed by the hospital ran roughly 14 programs in a health education center with two classrooms in the middle of Lankenau's facilities. Seven thousand to 10,000 students from kindergarten through 12th grade took courses each year in physical health, like nutrition, as well as social health issues, like bullying and harassment.
Now, part of the mission of the farm is to serve as what Onyekere calls a "learning laboratory" for classes about healthy eating, and to create a hands-on experience for students to learn about nutrition, gardening and building healthy behaviors.
Outside the hospital, Lankenau—in partnership with The Food Trust and the Philadelphia Department of Public Health—incentivizes healthy food buying by providing coupons called Philly Food Bucks. These coupons for fresh fruits and vegetables are valid at more than 30 farmers markets and are given to patients who express the desire for better access to healthy foods.
"From the moment the patient walks into the door to the moment they leave the office, that whole experience is focused on improving their health," Onyekere said.
Drew Harris, director of health policy and population health at Thomas Jefferson University's College of Population Health, said that only recently have health providers begun to take accountability for addressing food insecurity among their patients. A former practicing doctor with a specialty in diabetes, he remembers having a very different philosophy about chronic diseases and overall patient health.
"Like many doctors, I probably blamed the patients for not getting well," he said. "I didn't really ask the question: Did they have the ability to follow the diet they were supposed to follow as a diabetic?"
Harris eventually became interested in the wider issues that led to chronic illness. While some patients are never taught health literacy, he said, for others "challenges in life can intervene."
"Not having food security—not knowing where your next meal is going to come from or whether you can purchase everything you need to purchase when you need to—is a major challenge," he said.
What's more, the tools for patient treatment taught in the medical profession have been so focused on prescriptions and procedures, Harris said, that doctors do not always learn the importance of stressing to their patients things like how to create a balanced diet and where to access those foods—knowledge that could keep people out of the hospital in the first place.
Though food insecurity is not a new issue, he thinks medical education is just starting to take a more holistic approach.
"There's a much stronger incentive to worry about why patients are not getting better and what we can do to avoid them getting sick in the first place, and a lot of it has to do with their social environment, their access to healthy food," he said.
Still, Harris stresses the need to pressure health providers. "Holding the medical profession more accountable for results—the quality of the care they provide—is going to make a difference," he said.
Onyekere estimates that Lankenau has provided farm produce to about 400 patients so far, and the hospital is about to launch a survey of patients to better understand the program's impact. Although she said patients have expressed that the farm is making a difference and raising awareness of how to incorporate healthy choices into daily life, the research survey will be a valuable resource for other health providers considering similar initiatives.
Going forward, Lankenau plans to grow the farm with four additional raised beds. Though this year's yield far exceeded initial expectations, staff took that as a sign that it can further increase production. Onyekere said Lankenau is also looking to donate its food to additional community partners, like local food banks.
Lankenau is not the nation's only hospital-run farm. Others include St. Joseph Mercy Ann Arbor and Henry Ford West Bloomfield Hospital, both in Michigan; and St. Luke's University Health Network in Pennsylvania. But Onyekere is aware of none that have so extensively incorporated their own organic food into hospital life.
If America is to confront its growing chronic health epidemic, that integration is key, and, as these hospitals show, is already happening. "We're beginning to move from the patient outward to look more at the neighborhood and the larger environment in which that patient lives," Harris said.
Reposted with permission from our media associate YES! Magazine.
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'Wake up, humanity! Time is running out!'
At high Noon Sunday, with temperatures heading toward 95 degrees, I'm confident I was not the only one preparing to march through the streets of downtown Philadelphia who recalled that old elementary-school story about the wig-wearing drafters of the Declaration of Independence huddled inside of Independence Hall on a sweltering July day.
The U.S. Environmental Protection Agency's (EPA) detection of arsenic, a known human carcinogen, barium and other contaminants in the well water of homes near natural gas drilling operations in Dimock Township, Pa., should prompt a nationwide investigation of drilling-linked water pollution.
"EPA and other officials must move quickly to ensure these families have an adequate source of clean water," said Dusty Horwitt, senior counsel with Environmental Working Group (EWG). "This finding confirms what Dimock residents have said for months—that the Pennsylvania Department of Environmental Protection should have never allowed Cabot to end deliveries of clean water."
Last month, EWG published a report called Gas Drilling Doublespeak that found that Dimock residents, among other people in gas-rich areas, were not warned of risks to their water supplies when they were approached to lease their land for drilling.
EPA officials in Philadelphia announced they would deliver clean water to the four affected households and conduct broader testing at about 60 more homes in south-central area Susquehanna County. Cabot Oil & Gas Corp., the Houston-based company that began drilling for gas in the area in 2008, delivered water to the households under a 2010 consent agreement but stopped Nov. 30 after state regulators determined that Cabot had met its obligations.
According to an EPA action memo, agency scientists found the four households’ well water contaminated with arsenic and other hazardous substances “at levels that present a public health concern.” Some of these “are not naturally found in the environment,” EPA officials said, and may have been released by drilling activities. Among the toxic substances found in the well water, according to the EPA:
Arsenic, classified by the US government and World Health Organization as a known human carcinogen, an element sometimes found in “elevated concentrations” in groundwater because of drilling;
- Barium, a common constituent of drilling fluids; long-term ingestion at high levels can cause kidney damage
- Phthalates, a synthetic plastic chemical and probable human carcinogen, according to EPA
- Glycol compounds common in drilling fluids and associated with damage to kidneys, the nervous system, lungs, heart, testicular damage and anemia
- Manganese, an naturally occurring element that can damage the nervous system at high levels
- Phenol, found in some drilling fluids; at high levels can cause irregular heartbeat, liver damage and skin burns
- Sodium, compounds found in some drilling fluids, at high levels can cause high blood pressure
Federal officials said that although the investigation has not been completed, they have concluded, based on samplings to date, that a “chronic health risk exists” for the wells in question.
"These results also show that the families ultimately need a permanent source of healthy water, which the state has so far failed to deliver," Horwitt said. "Cabot should bear the cost of providing this, not the taxpayers."
For more information, click here.
Environmental Working Group is a nonprofit research organization based in Washington, D.C. that uses the power of information to protect human health and the environment.