Healthier Bodies, Healthier Communities
Ceres Project nourishes those in need, and the futures of young volunteers
By Kirsten Jones Neff
On a warm spring afternoon, a flock of particularly self-satisfied looking hens fluff and douse themselves in dust amidst raised beds full of kale, garlic, potatoes, beets, cabbage, bok choy, snap peas, beans, summer and winter squash and leeks. This happy place is the Ceres Community Project garden in Sebastopol, a large (almost an acre) sun-exposed plot with a serious purpose: to stock the Ceres kitchens with organic produce that volunteers will transform into nourishing meals for members of their community coping with critical illnesses.
At a potting bench, Kayden Elmer-Schurr, a senior from nearby Analy High School who has volunteered with Ceres for two years, transplants kale starts. “I joined Ceres because I was looking for some way to get involved with my community, to form a community connection,” says Elmer-Schurr. That connection, says Ceres founder and CEO Cathryn Couch, has absolutely everything to do with the health and well-being of a community.
Since 2007, the Ceres Community Project has provided North Bay teens and adults with the opportunity to come together to prepare free and low-cost organic meals for those facing a serious health crisis. In June of 2017, Ceres became part of a statewide, three-year, $6 million dollar pilot project championed by State Senator Mike McGuire and funded by the State of California, through which Ceres and five other nonprofits from across the state are providing medically- tailored meals to Medi-Cal patients with congestive heart failure. The state is tracking the health outcomes and health care savings that result from what Couch describes as a “medical nutrition intervention.”
It is difficult to find anyone who is truly satisfied with the way our health care system currently functions, but few have systematically worked toward solutions the way Couch has over the past five years. In order to understand the evolution of this health care activist and her nonprofit, we must go way back to a childhood full of family meals and learning to cook healthy food “by osmosis,” then earning an MBA, and gleaning an in-depth understanding of food systems from years as communication director of a San Francisco based nonprofit called The Hunger Project. Couch also witnessed up close the difference nutrition made for those living with HIV at the peak of the AIDS crisis.
With these life experiences, Couch moved to Sonoma in 1993 and founded the North Bay’s first gourmet vegetarian and organic meal delivery service. While running that business, she encountered many clients who were in the midst of a health crisis, so when a friend asked her to teach her teenage daughter to cook, Couch had an “aha!” moment.
“I was working with my friend’s daughter and ended up putting a project together delivering meals to three families in the community who were dealing with health problems,” says Couch. “Then I woke up one day and realized that this was an idea for a nonprofit. At that time I didn’t even realize what the win would be for young people in cooking for someone in real need in the community. Now we’ve unpacked layers and layers of value for the community and huge development benefits for young people.”
Ceres has grown exponentially, with three kitchens (in Sebastopol, Santa Rosa and San Rafael) and two gardens (in Sebastopol and Santa Rosa) engaging 430 youth and 600 adult volunteers annually to serve a total of 711,000 meals to people in need over the course of the past 12 years. Understanding the impact healthy food has on medical outcomes, Couch was not surprised when in 2013 a study by the Metropolitan Area Neighborhood Nutritional Alliance in Philadelphia, Pennsylvania (MANNA) and published in The Journal of Primary Care and Public Health, showed a 28-32% reduction in health care costs when patients were provided 100% of their required nutrition for six months.
The passage of the Affordable Care Act in 2010 had introduced “Values-Based Care,” opening the door for health care organizations to look at the array of factors leading to patients’ health outcomes, and a national group called the Food Is Medicine Coalition promoted the conversation around medically tailored meals as a critical piece of health care. As advocacy and opportunity around nutritional interventions grew nationally, Couch joined the conversation.
“In 2016, I reached out to State Senator Mike McGuire, who had been supportive of our work at Ceres, and talked to him about what was happening nationally. I explained the ideas around thinking of our work as a medical intervention. Mike got it right away and said, ‘What’s needed?’” What Couch was interested in seeing was what she calls “game-changing” research. The Philadelphia study was not large enough to be extrapolated into more settings, and she saw an opportunity to conduct a larger study here in California. “The interesting thing about California is that there are six medically tailored meal providers across the state, including Ceres, so, collectively, we cover 50% of the state population. We brought together a team that covers San Francisco and Alameda, LA and San Diego, and then up here in the North Bay, and began working in Sacramento with our elected officials.” The efforts of this group, called the California Food Is Medicine Coalition, resulted in groundbreaking legislation that defines what a medically tailored meal is—the first time that has been codified into statute—and created the first- ever statewide multi-agency pilot, which is also the first-ever to provide data about medical nutrition interventions for the Medi-Cal database.
“The Ceres Project has done life-changing work in Marin and Sonoma counties,” said McGuire in a press release announcing the pilot. “The bottom line: We believe, over the next three years, we’ll demonstrate enhanced health outcomes for chronically ill Medi-Cal patients and save millions in health care costs.”
The California Department of Health Services, which oversees the program, selected congestive heart failure because it is an expensive population for the state with high readmission rates. As Couch describes it, patients with congestive heart failure are particularly prone to diet-related setbacks.
“This is a very low-income population, Medi-Cal is for people who are at or below 138% of the federal poverty level, so they are low-income and they are very sick,” she says. “They come home from the hospital, they don’t feel well the heart is not working well. You’re not getting enough oxygen, so standing, shopping, that is very difficult, and people rely on low-quality processed food, which are high-sodium foods. This means they retain water and it puts more stress on their hearts and they end up back in the emergency room.”
The pilot is called a “medical nutrition intervention” because it offers 100% of participant’s nutrition for 12 weeks with four focused visits with a registered dietitian, so participants gain knowledge about why certain kinds of food are good for them, and how to eat on a budget in a way that will support their health and keep them out of the hospital. It also includes case management support to not only enroll people in the intervention but to keep them enrolled.
At the conclusion of the three-year pilot, outside evaluators will look at outcomes and health care utilization and costs for patients who received meals compared to those who did not. A year into the study, the results are very good, showing significantly lower readmission rates for those receiving intervention compared to Medi-Cal patients with congestive heart failure across the state.
However, there remains, in Couch’s words, a “big nut to crack.” The pilot is reliant upon the health care providers for referrals and while Couch says everyone she meets with is excited about the potential of medically tailored meals, the program is far below its target goal of 1,000 Medi-Cal patients, the number of enrollees needed to be the “game-changer” the study has the potential to be. As of June 30, 2019, the number of patients enrolled from across the state was 256, and the average number of new enrollees each month was 30-40.
“It’s a challenge because you’re working with people in health care centers who have a lot on their plates. There is a big focus on how do we connect patients to community-based resources, but there is no funding structure for that, there’s no designated person in those settings to do that linkage, and they’re trying to add it in to someone’s role.”
In other words, Crouch and her California Food Is Medicine colleagues are trying to create a system-wide change, one that supports caregivers as they support the nutritional health of their patients. Coalition members are working tirelessly to introduce the program to health care providers, through webinars, conferences and meetings across the state.
“This is a strategy for radically expanding healthy food access to an extremely vulnerable population. If the pilot is successful we crack a door open at the state level so this can become policy. If we make it successful, the Department of Health says, ‘OK, what’s the next diagnosis we can address?’ If we don’t make it successful, the door closes.”
In early April, University of Washington epidemiologists published findings in The Lancet: A Global Journal of Disease: Poor diet is responsible for more deaths around the world than any other factor, including smoking. In New Orleans, The Goldring Center for Culinary Medicine at Tulane University is the first medical school to provide hands-on nutritional training for medical students. The time to recognize diet as an essential part of medical care is past due, a fact that is not lost on volunteers back in the Ceres kitchen in Sebastopol where produce from the garden has made it into the meals made by teen and adult volunteers. These healing and medically tailored meals are now helping community members with the most serious diseases, including cancer, heart disease and diabetes.
Wanting to connect students to the humans who benefit from their work, Program Manager Tina Green regularly brings clients who have received meals to meet the teen gardeners and chefs. “It is very powerful. They hear the impact of the meals on someone’s illness, the difference Ceres meals have made for them. We discuss the pilot program and the health care policy aspect of this work with the teens, and their reaction is always awe.”
Making a difference is powerful fuel, and beyond the fact that Ceres is now paving the way for medical nutrition intervention as a central part of health care, the most telling indicator of long-term impact may be that, according to a recently published Ceres Youth Impact Report, 58% of teens who have gone through the program go on to study or work in public health, nutrition, medicine, community organizing, sustainable ag and culinary work. Age “14-19 is the moment. They are leaving their family of origin and the question is: How do I belong in the larger world?” says Couch. “There are not many places where young people are considered owners and full contributors, where they can experience their belonging as a contributing member of the community and access their sense of agency.” These young people will be our health care leaders, the advocates who will shape our food and health policy. They are the future Cathryn Couches of the world.
