Engage Communities to Improve the Success of Future Michigan Food Insecurity Solutions

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Executive Summary

Food insecurity is a persistent problem within Michigan. Food insecurity puts individual Michiganders’ health at risk and has high economic costs at the state level. One state-level program that aims, in part, to address food insecurity is the Value-Added and Regional Food Systems Grant Program. To improve the success of this grant program and other Michigan food insecurity solutions, legislators or administrators should modify the grant to require community engagement.

Key Recommendations

• The Michigan state legislature or the Michigan Department of Agriculture and Rural Development (MDARD) should modify the Value-Added and Regional Food Systems Grant Program to require metrics that measure community engagement.
• The community engagement metrics should be monitored over time so that MDARD can collect and analyze data. The goal is to build knowledge around what community engagement strategies best support food insecurity solutions in Michigan.

Definitions

• Food insecurity is when “the availability of nutritionally adequate and safe foods or the ability to acquire acceptable foods in socially acceptable ways is limited or uncertain.”
• Drawing from a definition used in healthcare research, community engagement, as used here, refers to systematic efforts to incorporate the needs, values, and preferences of a community into decision-making.

Food Insecurity Costs in the State of Michigan

Food insecurity takes a toll on millions of Michiganders — approximately 1.3 million Michiganders were food insecure in 2019, and estimates for 2020 show this increased to 1.9 million people — and has high economic costs at the state level. In 2010, Michigan’s hunger bill was calculated to be $5.51 billion (the most recent data). For perspective, Michigan’s total spending was $90 billion in 2020. This hunger bill captures costs related to poor education outcomes, lost economic productivity, charity, and avoidable health care costs. Michigan’s annual statewide healthcare costs associated with food insecurity are over $1.8 billion dollars per year (greater than the 75th percentile for annual statewide health care costs associated with food insecurity in the U.S.).

MDARD administers the Value-Added and Regional Food Systems Grant Program that aims, in part, to address food insecurity.

The state legislature has authorized the grant program and provided funding annually to support projects. MDARD draws on legislative statute language to set grant criteria and scoring [1]. Funding for these MDARD grants focuses on food hub development, food access, and enhancing agricultural products. A mandatory part of applying for these grants is identifying project outcome-oriented goals and corresponding performance measures. Projects are scored, in part, based on their inclusion of “meaningful, measurable, and realistic outcomes” and the “social impact benefits for the project.” Reporting on the outcomes and impacts of a funded project may be required for up to three years after the grant period ends.

What do we know about community engagement and food interventions?

Community engagement supports successful food insecurity solutions. Research focusing on supermarket interventions found community engagement to be an important contributor to intervention success in terms of a store opening and staying open. In addition, in 2019 the Michigan Public Health Institute (MPHI) created an inventory of what is being done across the state of Michigan to ensure access to affordable, fresh, and healthy food. Part of MPHI’s research was interviewing 16 “key informants.” In describing what makes particular programs successful several organizational qualities and community engagement strategies were named, including evaluating efforts and tailoring interventions to a local community context. Limitations include transferring results from supermarket interventions to other food interventions and generalizing interview responses.

Community engagement applied to healthcare has achieved significant cost reductions. For example, the Cleveland Clinic reduced total care costs by 6% after patients and families engaged with clinicians and care plans. ThedaCare redesigned inpatient care to focus on adding value to the patient experience — including gathering patient input — which led to a 25% reduction in inpatient care-related costs. With a hunger bill of $5.51 billion, Michigan could realize significant cost savings by engaging communities in implementing food insecurity solutions.

Many community engagement process and outcome metrics exist in healthcare decision-making. Measuring outcomes tells you whether a proposed project was successful while measuring process provides information on how and why. Leveraging metrics requires monitoring so grant recipients and MDARD can evaluate efforts. Evaluating process enables evidence-based adjustments throughout a project. Evaluating outcomes provides information on what types of projects — and associated processes — are ultimately successful. Here, process metrics would measure how grant recipients engage communities and outcome metrics would measure the results of that engagement. Limitations include insufficient evidence to support using particular metrics for food insecurity solutions.

Below are example metrics and how they might be measured using closed- and open-response questions. The use of both closed- and open-response questions is aligned with best practices for mixed methods research.

Policy Recommendations

Given the current opportunity for significant cost savings at the state level and drawing on healthcare and food insecurity research, the Value-Added and Regional Food Systems Grant Program should require recipients to engage communities by requiring at least one community engagement process metric and one outcome metric in each application. MDARD should monitor grant recipients’ chosen community engagement metrics to evaluate them. MDARD can help determine which metrics improve food insecurity solution success in Michigan by evaluating metrics across funded projects.

• The Michigan state legislature or MDARD should modify the Value-Added and Regional Food Systems Grant Program to require process and outcome metrics that measure community engagement.
• The community engagement metrics should be monitored over time so that MDARD can collect and analyze data. The goal is to build knowledge around what community engagement strategies best support food insecurity solutions in Michigan.

References

[1] “[Info Request] MDARD Value Added & Regional Food Systems Grants,” Personal correspondence with Heather Throne, Grant and Commodity Program Manager, Agriculture Development Division, 2022. [2] Dukhanin et al., “Metrics and evaluation tools for patient engagement in healthcare organization- and system-level decision-making: A systematic review,” Supplementary file 4, Int. J. Heal. Policy Manag., vol. 7, no. 10, 2018. [3] Riddick et al., “The health planning process: are consumers really in control?” Health Policy, vol. 4, no. 2, 1984. [4] Abelson, “The Public and Patient Engagement Evaluation Tool,” PPEET Research-Practice Collaborative.