By Steven Bae and Lauren Wilson, MEDS 2019

“Let food be thy medicine, and medicine be thy food” – Hippocrates

Food. It is a vital part of our existence, and is a focal point in many cultures. Over the course of one year, a person who eats three meals a day consumes 1092 meals. It plays such a large role in everyday life that sometimes it is easy for us to overlook.

The importance of food security to one’s overall health is well known. Food security is defined as “all people, at all times, have physical and economic access to sufficient, safe, and nutritious food to meet their dietary needs and food preferences for an active healthy life.” [1] A recent JAMA study reported that suboptimal intake of nutrients and healthy foods was associated with over 45% of deaths due to heart disease, stroke, or type 2 diabetes. [2] Yet for too many people, adequate access to nutritious food is out of reach. Some of these people live right in our community.

Photos courtesy of Loving Spoonful

The neighbourhoods in North Kingston make up 20% of the total population, and their average income is 22% lower than the city average. [3] The people living in North Kingston are twice as likely not to have completed high school, and twice as likely to be living on low incomes. [3] Many physicians that know their patients may not always be able to afford food ask their patients at appointments if they have enough food. Some family health teams even have an emergency supply cupboard in their office for extra food to give to patients who need it.

To increase awareness of these issues, we became closely involved in helping develop a service learning project in partnership with Loving Spoonful,  an organization that works to achieve a healthy, food-secure community. The project is structured around community cooking programs for low-income Kingston residents with medical students as volunteers. On top of building food literacy and confidence in preparing healthy foods among class participants, the goals of the project were to expose medical students to the Kingston community, provide information about food security in Kingston, and encourage them to create a dialogue with the participants in order to learn more about what they can do as future physicians.

The project also allows for students to accompany a physician from the Kingston Community Health Centres to visit the home of a patient living on a fixed income. The students have found that this experience has been eye-opening to appreciate firsthand the ways in which barriers can be specific to individuals. For example, if an individual has difficulty standing, the food s/he buys has to be prepared quickly, which limits his or her choices. Underpinning all of these experiences is a facilitated debrief and written reflection at the end, which allows students to share and document their insights, challenges, and surprises.

Ten medical students have participated in the service learning project thus far, with more students registered for this fall. All of the students have enjoyed this project in many aspects, from improving their own food preparation skills, to developing rapport with the local Kingston residents.

Overall, we are walking away with a greater appreciation for the social determinants of health. As future physicians, the social inequities that underlie many chronic diseases may seem insurmountable. However, this work is not solely our own. Organizations like Loving Spoonful play an important role in our community to address upstream factors that we eventually see presenting as illness. Being knowledgeable about the resources available in our community is a small but helpful step we can take to help our patients address challenging socio-economic circumstances.

Thank you to Loving Spoonful for your invaluable partnership in developing this project and the Kingston Community Health Centres health team for contributing to student learning. We would also like to gratefully acknowledge the City of Kingston and United Way for their Community Investment Fund, as well as the Kaufman Endowment fund, which helped fund this program.


References
[1] Committee of World Food Security
[2] Micha R, Penalvo JL, Cudhea F, Imamura F, Rehm CD, Mozaffarian D. Association between dietary factors and mortality from heart disease, stroke, and type 2 diabetes in the United States. JAMA 2017;317(9):912-924.
[3] Kingston Community Health Centres. A community needs assessment of North Kingston neighbourhoods. June 2010