101 Cathryn Couch served 1m medically tailored meals to low income people with health challenges

Food is medicine but could also be poison says Cathryn Couch,  founder and CEO for Ceres Community Project, who has served over 1m organic medically tailored meals to low income people struggling because of a health challenge.

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Ceres Community Project is a non-profit organization working to foster health by connecting people to one another and to a healthier food system.

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Transcript

SPEAKER_00: 0:00

Food is medicine, but it could also be poison, says our guest, who has served over 1 million organic, medically tailored meals to low-income people struggling because of a health challenge. We talk about food as medicine a lot, but we usually discuss ways of measuring nutrient density, soil health, etc. But we hardly cover the medical side of things. Who is mostly at risk of chronic illness are the people who can't afford a healthy meal to begin with. So how do we make food as medicine part of every medical discussion? And how do we bring soil health into that conversation as well? Our guest of today is showing that it's a much better investment to provide someone healthy food than to deal with the effects of cheap processed food later, like a very expensive readmission in a hospital. Welcome to another episode of In March last year, we launched our membership community to make it easy for fans to support our work. And so many of you have joined as a member. We've launched different types of benefits, exclusive content, Q&A webinars with former guests, ask me anything sessions, plus so much more to come in the future. For more information on the different tiers, benefits and how to become a member, check gumroad.com slash investing region. an egg or find the link below thank you Welcome to another episode today with Catherine Couch. She's the founder and CEO of Sarah's Community Project, a nonprofit working to foster health by connecting people to one another and to a healthier food system. Sarah's provides 185,000 organic medically tailored meals, and we're going to ask what that actually is, annually to low-income people who are struggling because of a health challenge. Youth volunteers grow the food and prepare the meals as part of a youth development culinary and food system education program. Welcome, Catherine.

SPEAKER_01: 2:15

Thank you. Great to be with you.

SPEAKER_00: 2:17

So to start with a personal question. How did you end up focusing on medically tailored meals? Background in food, background in soil, background in egg. What was the journey to this very specific part of the food system?

SPEAKER_01: 2:29

Yeah, so I actually have a business degree, a master's in business and started my career in marketing and marketing research. But I've always had a really big interest in food and health. And in the late 80s, I ended up as the communications director for a national nonprofit called The Hunger Project that was working on educating Americans about the solutions to global hunger. And then in the early 90s, after I left the Hunger Project, I started a home-delivered, a vegetarian organic home-delivered meal service. And it's really hard to remember back then because literally there was like two vegetarian restaurants in the Bay Area. Organic food was still pretty ugly and very hard to find. And there were no meal delivery services. I mean, it's just like, it's so radically different now.

SPEAKER_00: 3:14

For anybody listening that cannot imagine that, that's not so long ago. And it was like that. Yeah,

SPEAKER_01: 3:18

no, it's like we've got so many options now, right? And every grocery store has prepared meals. I mean, it's such a radically different environment. And I ran that for 10 years and then I was doing some catering and some other things. And what happened is in 2006, a mom that I knew asked me to teach her daughter how to cook over the summer and hire her. And it's hard to hire someone for a catering gig who doesn't know how to cook. And so I was kind of annoyed by this request. And ultimately I ended up putting together a project in 2006 where this teen and I met once a week for seven weeks. And I found three families that were going through a health crisis and we prepared meals for them. One of them was a mom with stage four metastasized breast cancer and two preteens, 11 and 13. And the first week that we cooked the dad and that family came to pick up the meals and I introduced myself and Megan and I started talking to him about what we had made and literally you could physically see the relief in his being that someone was doing something to relieve stress for him and his family and at the same moment I glanced over at Megan and she looked about six inches taller there was this moment where she realized that this wasn't about chopping onions it was making that kind of difference in someone else's life. And that moment came and went. But three weeks later, I woke up at 630 in the morning and I literally had a download of what this opportunity was to connect two things that I felt really deeply about. One was the fact that so many young people today are growing up in families where cooking does not happen and family dinner does not happen. And so that fundamental life skill, right, the ability to prepare a healthy meal for oneself and one's family is that I essentially learned by osmosis because cooking happened in my family three times a day, was not happening for so many kids. And that really puts them and their future families at risk from a food system that is profit-driven and does not really care about their health. And so that was really exciting to me. And then at the same time, to know that when people are sick and they most need to eat healthy food, it tends to go to the bottom of the list for a whole host of reasons It felt like the exciting thing for me at that moment was we could address both of these things in one solution. So that was the seed. And I ended up starting Ceres in March 2007 with six teens in a church kitchen providing meals for four families. We've now provided over a million meals. We've trained a dozen communities around the U.S. and now in Denmark to replicate our model. And more importantly, I've now gotten into the policy space and really food is medicine. So it's been a journey. But over the last five years, we've moved more and more to this medically tailored meal model. So we always did 100% organic food. We've always done really healthy meals, no added sugar.

SPEAKER_00: 6:16

Yeah, but what is a medical tailored meal? It doesn't sound tasty, but I know it is. So walk us through like a typical, I mean, it's

SPEAKER_01: 6:24

a policy term.

SPEAKER_00: 6:25

Yeah. What is the medical tailored meal?

SPEAKER_01: 6:27

Yeah. I mean, so we've always done really healthy food, 100% whole grain, organic, no added sugars, all that. But as we move more and more into working with people, especially with a range of chronic health conditions. If you look at low-income populations, diabetes, heart disease, hypertension are really prevalent. And many of those patients have multiple of those illnesses. We started to realize that our meals needed to be more than just healthy. They needed to really take into account the specific health conditions that a patient was dealing with. So for example, for someone with diabetes, it's really important that you control the number of grams of carbs in each meal and they need to be pretty consistent. So for example, one of the things that we found was a lot of our vegetarian meals had too many carbs for a diabetic patient. So we had to start making adjustments. Same thing with heart disease. You have to control for sodium and you have to control for saturated fat in order for that meal to truly be as healthy as it needs to be for that patient. So if you have someone with congestive heart failure who comes home from the hospital and they eat high sodium meals, Regardless of how healthy everything else is, they're going to retain water and that's going to put pressure on their heart and they're going to end up back in the emergency room. It's a higher level of understanding that for people with health conditions, you have to really take into account the specific nutritional needs of that patient and tailor the meals to meet that. So currently our basic diet meets what's called the DASH diet standards for cardiovascular disease. And then we tailor for diabetes and also for chronic kidney disease. The basic diet is good for most people. It's saturated fat controlled, sodium controlled, reasonable amount of carbs. Certainly for anyone with cancer, most illnesses, that's going to be fine. But if you have chronic kidney disease or diabetes, you're going to need something else. And we currently actually don't serve people with renal failure because that diet is really complicated and we're not ready yet to take that on. So it's that next level, right, of nutrition and understanding and matching the meal to the specific patient and their needs.

SPEAKER_00: 8:38

And what makes you different? Because you've said we're 100% organic. We really focus on the health side of things. You sort of imagine that because you're not the only one providing these medical tailored meals, they're mostly funded through state programs or like they're government funded. It's not the participants itself. You would imagine that the others also focus on providing healthy meals. But in our previous conversation, you did highlight that probably that's not the case. Like, I mean, I don't understand why are they not focusing on the healthy side of things? Is it really true? Like highly processed meals ends up your client, your partner into the hospital probably a lot earlier. What's going on there in terms of the healthy versus the non-healthy medical tailored meals? Because that means that medical tailored meals is actually not very good for you from a medical perspective.

SPEAKER_01: 9:25

For some many ways to start answering this question. I want to make a point that So when we talk about food quality, it means a lot of different things depending what hat you have on. So when a registered dietitian nutritionist talks about food quality for someone with diabetes, they're talking about the specific nutrients in that meal. They're talking about how many grams of carbs, how many grams of protein, how many milligrams of sodium. They're not talking about how much nutrition is in the carrots or the soil or is that food organic?

SPEAKER_00: 10:03

And that's how we get introduced through. Then Kittredge introduced us like you have to talk about food as medicine because Catherine is going beyond the carrot, like not saying you should eat more carrots, which for many people is already an amazing first step. But unless we go beyond eat more veggies, eat your veggies, eat this quantity wise, we need to start looking at the whole system behind it. And I think they're organic is an amazing start. And you've sort of consciously or unconsciously made that decision. And now you're being pulled into the regenerative space, basically, and looking at food and medicine, speaking at the Bionutrient Food Association events. And it's like, what do you see there happening? When you put your own hat on, what do you think, what do you see as food quality?

SPEAKER_01: 10:42

So I want to just go back and say that medically tailored meals in the United States started during the AIDS epidemic. So during the AIDS crisis in the late 80s and early 90s, individual organizations sprung up around the country. You know, AIDS patients were dying of the disease, in many cases, their family were abandoning them because they were gay. And individual people like I did with my organization started nonprofits to provide meals to people with AIDS and HIV. And a lot of that focus was in the beginning on just comfort, right? And so there wasn't a sense of food quality. Then meals started to get better. One of the things that happened was they learned really early on when AIDS patients have high quality medically tailored meals, their nutrition improves and their viral loads actually go down and they're less able to transmit the AIDS virus. So they learned that really early on and that led to the federal government including home-delivered medically tailored meals as a covered benefit in the Ryan White Act, which is still the federal funding stream in the U.S. for AIDS HIV. So that Ryan White funding supported dozens of non-profits around the country in developing medically tailored meal programs. Then the AIDS crisis really changed. It became much more of a chronic illness The need was different. And essentially what happened was Avon and Komen, who were working with breast cancer patients, came to those organizations and said, if we provided funding to you, would you serve breast cancer patients? And so it went from there. And now most of these nonprofits who really develop the medically tailored meal model provide meals to people all over the country. We have funded that almost exclusively with philanthropic dollars until just recently. And now this group of organizations called the Food is Medicine Coalition in the U.S. are really leading the work to integrate medically tailored meals into public and private insurance as a covered benefit. So I just want to clarify that there's not a lot of government funding or even private health. It's starting to happen now. And as medically tailored meals have taken off and there started to be health care dollars becoming available for them, no surprise, many for-profits have also gotten into the space, right? So large for-profits are developing medically tailored meal models. There are companies now that will drop ship meals anywhere in the country for a certain amount of money. And for the most part, while their meals meet those nutritional requirements that I talked about, they do not have any focus on food quality in the way that we would talk about it. So how that food is grown, how that food is sourced, even things like whole grain additives, all of that stuff, they tend to be pretty poor quality meals. But for a health insurer, if I can sign up with one company, get a meal shipped anywhere in the country to my clients for$7.50 a meal, that sounds like a really good deal, right? And it's nutritionally appropriate. So this is where we have to start challenging the conversation. Among my colleagues that do this work, we are the only 100% organic provider, but everyone is is making meals from scratch, is sourcing some organic food, is thinking about whole grains versus not whole grains, is trying to buy locally. They're moving in that direction. And I want to say, every company and organization has its legacy history that it takes a while to move. I was lucky. I started with a focus on organic. My board and my funders supported that. And so it's all good to go. But if you've had a different model, it takes time to change that. But I think... What I was saying to you earlier is that one of the challenges here is that we're trying to bring medically tailored meals into the healthcare space. We're trying to connect the dots between our food system and the way that we fund food programs in the US and healthcare and trying to make the point that If we underfund food, we end up essentially paying for it on the healthcare side. We have to start connecting the dots between those two and understanding that food is the first line of defense against illness. It is not complicated, but there's a lot of misinformation. And for many people in most countries who are low income, the ability to access the kind of quality food that you need to be well is very, very difficult. And so no surprise, people go to McDonald's and they buy processed food and they buy cheap food because that's what they can afford for their families. And so, and again, that's the underinvestment. In the U.S. in particular, our health outcomes are far worse than any other developed country. And it's not because we're we spend less on health care. It's because we spend less on social care. We are under investing in the kinds of things, including food, that allow people to build healthy, productive lives. And then we pay for it over here. But we're not talking about the fact that those two things are connected. And that's where we really have to shift. And, you know, in terms of food quality, as this revolution happens, where health care dollars, every insurer, every hospital is going to start paying for food as part of care, because the bottom line is it works.

SPEAKER_00: 16:20

It Do you have an example of that? Because I know you're working on a number of them in California, like this discussion on$7.50 and$7.59 or 49 to get it down just an inch cheaper there is really not very productive because you pay for it down the line because somebody gets back to the hospital 10 days later, which is extremely expensive. So you've been showing, actually you and colleagues and other people in the space have been showing the absurdity of that system. Can you show like an example of how you're trying to change that policy and getting the food, not as a, not Yeah, there's about six or seven published peer-reviewed research

SPEAKER_01: 18:05

studies. in the US around medically tailored meals. Most of them were one nonprofit organization in one community. Some of them are retrospective studies. Some of them are prospective studies. Pretty much consistently, they show that there's about a 16 to 20% net savings on the healthcare cost side when you provide a medically tailored meal intervention. Very general. Lower readmissions, more likely to be discharged to home, better medication adherence, like a whole bunch of different things. So one of the challenges that I was finding as I was talking to health care providers is they were all saying, well, that's so great that that happened in Philadelphia, but how do I know what happened here? So there was a limit to like what those studies should show. So I was able with our state senator in California and a group of colleague organizations in the state to get California to fund the first in the country statewide pilot of medically tailored meals in the Medicaid system. which is our low-income healthcare system. So these are all patients that are very low-income, and they all have congestive heart failure, which is, it's the most likely readmission. So congestive heart failure patients are more likely to be readmitted to the hospital within 30 days or 90 days than any other diagnoses. It's because of the nutrition impacts of the disease. So if you were eating a high-sodium diet, which is very likely if you're poor, and especially if you don't have Thank you. We are showing dramatically reduced readmission rates for people who are getting the intervention. We're also now doing a large-scale randomized controlled trial with Kaiser Permanente, which is a national healthcare system that uniquely is both an insurer and a provider. So they have very detailed data on their members and are able to really do a lot of analysis. They have a very, very strong in-house evaluation team. So there's four studies happening right now. The one that we're doing is congestive heart failure die and chronic kidney disease. There are patients who are being discharged. They're comparing Kaiser's usual standard of care with 10 weeks of meals for everyone in the family, with 10 weeks of meals for everyone in the family, plus support from a registered dietitian around health coaching and nutrition education. And we expect from all the existing data that that's going to show Very dramatic results. And as a result already, Kaiser is planning in 2021 to provide medically tailored meals for seniors with congestive heart failure, which is possible because in 2020, the Medicare system in the U.S. had made some changes that will allow medically tailored meals to be a covered benefit. if you believe it will prevent another cost, essentially. And that's what we're driving to now in California is building into the Medicaid system that you can provide home-delivered and medically-tailored meals in a number of different cases because it will prevent the cost of a readmission or an emergency department visit. So that's the cost. There's really good data. And I'll just say, literally, every major insurer in the U.S. is active in this space right now. They're doing pilots.

SPEAKER_00: 21:42

So what has to Why is that now we're talking 2020 compared to when you started 2007? Why suddenly food and let's talk about soy in a minute, but let's say food as medicine, you have it in your email signature. Like why suddenly that sort of shifted? Do we have a hunch, but maybe we don't know, but it seems to have shifted the last few years.

SPEAKER_01: 22:03

Yes. I think there's two things that have happened. One is there is a growing understanding that we are not going to drive improvement in health outcomes or control healthcare costs without addressing what are called social determinants of health. There's a real understanding now. So the data basically shows that only 20% of your health is driven by what happens in a clinical healthcare setting.

SPEAKER_00: 22:30

Wow. And that's where we invest all our money. Like all med tech or everybody is going after the latest X, Y, Z, et cetera.

SPEAKER_01: 22:40

30% are the choices you and I make every day. Eating well, stress management, not smoking, exercise, not overusing drugs, like all of those lifestyle changes, that's 30%. But 40% are what are called the social determinants of health. Those are the things that impact people's ability to make those healthy choices. So if you're poor, you live in an area where it's not safe to walk outside, you can't access healthy food, you don't have access to transportation, all of those things are 40%. So 30% 30% are choices, 40% of things that limit choices.

SPEAKER_00: 23:16

And then 10%, sorry, now I'm curious.

SPEAKER_01: 23:18

10% is like environmental factors, genetics and environmental factors. So I think what's happened is as that realization has grown, healthcare has been pressed to realize that they have to now think about those things that happen outside the doctor's office. And when you look at that space, when you look at housing, financial literacy, financial empowerment, food becomes the easiest and the cheapest thing to take on. I mean, it's way easier to talk about food security and nutrition security than changing housing policy, like getting more people well-housed. That's like a big thing to take on. Improving wages, like that's a big thing to take on. Food is cheap and it's fast. And so I think it's driven this realization that Humana, who's an insurer in the Southeast, I heard this at a conference a couple of years ago and it really struck me, They realized that for Medicaid patients, Medicaid patients were 29% more likely to end up in the emergency department the last week of the month. Why? Because they run out of food. Most of them are diabetic or pre-diabetic. They continue to take their medication, but they're skipping meals. And that has them become, I'm not going to remember the term right now, but anyway, that causes a problem. They end up in the emergency room. So now they're testing, they're doing randomized controlled trials around a food security and way cheaper to provide food for that last week of the month than to have all those patients end up in the emergency department. So these kinds of realizations are happening. And we've been able to, again, drive some change in Medicare, where Medicare can now cover meals. Not many plans offered meals in the first year, but now there's peer pressure among the plans. And in the U.S. now, you can see ads on like TV where they're saying new Medicare benefits, home delivered meals. Like I know never in my wildest dreams thought that would have happened 10 years ago.

SPEAKER_00: 25:16

But is it going to be then, like, is there going to be peer pressure on the quality as well? Like tasty meals, healthy meals?

SPEAKER_01: 25:22

Well, that's the next stage. And that's part of the work that we're trying to do at Ceres is to drive conversations among our colleagues and among healthcare to hold a different standard. And I'll use Kaiser as an example, because I'm having a lot of conversations with them. They are in Northern California. They've committed to 100% sustainably source food at all of their facilities by 2025 and they're actively working on that

SPEAKER_00: 25:49

which is a massive buyer that's great for people working in this space these are if you can supply these huge

SPEAKER_01: 25:56

that massive buyer and so they're driving food system change in california because of that's awesome but then they go and for their medically tailored meals they're contracting with that for-profit provider who does not represent those values at all and i've said directly to them, you have to stop purchasing from them. That company does not align with your own values in this space. And if you invest in a community-based organization like Ceres for a little bit more, you are driving layers of community health benefit. So we educate young people. 78% of our adult volunteers improve their eating habits. We don't do any programming to them. It's just because they're involved. We're educating the whole community about food and health. We buy locally. We buy organically. So when you invest your dollars in us, you're buying a lot of things. When you invest your dollars in 775 drop ship from Iowa, you know, that is completely out of integrity with your values. Like we have to be able to say that stuff out loud and call people on it and raise their consciousness. It's a consciousness issue. They just don't think about it. They're in a mode of what's the cheapest solution. Like I'm in, what's the cheapest solution. And so we have to start raising those issues and saying, you have to think beyond those immediate dollars what is it you're buying with your money and what is in alignment with your values what do you want to model for your peers like you know Kaiser it's like you have the ability to model something for your peers are you willing to do that or not

SPEAKER_00: 27:59

and then if we're at I would say that level of discussion like look that you get what you pay for in terms of food in terms of quality etc how do you imagine shifting that conversation because you're having this conversation you're speaking with Dan etc on bringing in soil and going beyond organic and beyond that like how do we get soil health into that discussion because that seems like a huge other leap like from okay we're going to pay a bit more okay we're not going to ship it from wherever we're going to invest here do you see that or is that sort of a logical next step to get soil health into discussion and really slow show literally all the layers that are involved in in our food system

SPEAKER_01: 28:37

i don't think it's a leap at all i think it's just an extension of the conversation right because if you're you know kaiser saying they have this value around we're going to source sustainably. Okay. Like what's behind that? What's behind that is they're thinking about the environmental impacts, right? They're thinking about, like, for example, they care about, they've just invested in a new facility that makes their patient meals. And one of the things they're really excited about is that food facility is hiring people, immigrants and people coming out of the justice system and doing job training. So they're trying to think about all these, they know that health means people need to be economically healthy. People need to be, the environment needs to be healthy. We need healthy water. Like they know that. And it's just about taking them down that path where they understand the connections between the decisions they're making and those outcomes. So if you're buying organically and you're buying locally and you're buying from like big conversation in California now is BIPOC owned farms, like farms owned by people of color, farms owned by immigrant communities, like local small farms, we got to support small farmers. Like those conversations are all happening. And it's about connecting the dots and thinking about when you buy from an organization like Ceres, here's the farmers that we're supporting. Here's their soil policies. Here's how that supports

SPEAKER_00: 29:59

their welfare policies.

SPEAKER_01: 30:02

Addressing climate change, which is going to affect health. It's like, it's all connected, but you have to make the connections for people. You have to take them through that process. But again, I use Kaiser because they are thinking in the right way. Like as an organization, they're inclined to these conversations. And so, you know, if we can get someone like them. And

SPEAKER_00: 30:26

they're big, just for people to understand, like what's their size in terms of like, just to, for people that never heard of the word.

SPEAKER_01: 30:32

They, 95 million members, I think in the US, something like that.

SPEAKER_00: 30:38

That's massive. Yeah. If they are shifting, the rest will follow if they see results.

SPEAKER_01: 30:42

Well, Washington, so they're in Washington, Oregon, California, Nevada, Hawaii, you know, maybe eight or 10 states. And they've always been a real leader. And, you know, partly because they have the insurance side and the health care side, they've always connected. They

SPEAKER_00: 30:59

see the costs.

SPEAKER_01: 31:00

They see the costs, right. They see the costs. And so they're not disconnected. And they've always been very data driven and understanding what builds value. And, you know, they've just developed a whole national strategy called Food for Life. They're doing a lot of work around food and nutrition insecurity right now with their members. And they're doing a lot of really good things. But even there, it only goes so far. And that's where our job, I think, as advocates is to push them to go farther and to explain to them what's missing from their thinking and their decision-making process. And I think that's the work right now. As I said, there is a revolution happening in this country. There's so much momentum right now around food as medicine. And I'm part of the food lab at Google. And I was at a meeting there a couple of years ago. And I suddenly like, had this light bulb moment where I realized like this is all happening and it's happening really fast and everyone's getting in and there's like all this momentum happening. But the food quality and the environmental impact piece was like completely missing from the equation. And that was terrifying because it's such a huge missed opportunity. If we don't connect the dots now and we get those decisions to be made and those investments to be made in a way that also supports a healthy food system and a healthy environment and healthy soil, we have so missed an opportunity. And that has really driven me for the last couple of years.

SPEAKER_00: 32:28

And for the people working in the regenerative ag and food space, how can they be part of these discussions? What's the role for the farmer approach using regenerative practices, but also the food companies? There's a lot happening, but mostly it's not part of this system. Mostly it's not part of medical tailored meals. What can listeners of the podcast do? Also, if you're in other countries, what is needed to make sure soil is part of this revolution that is happening in terms of food as medicine?

SPEAKER_01: 32:54

I think what's really important and what I say a lot when I'm speaking is that you know, if you're on the healthcare side, you're thinking about chronic disease, you're thinking about healthcare costs, maybe you're thinking about nutrition and security. If you're on the farming side of this, you're thinking about the food system and regenerative soil and climate change and that side of the equation. We have to start, no matter what side of that equation you're on, you have to become facile and understand the other side of the equation. And we all have to start talking about that full circle and not just our piece of it. That's, I think, what the big opportunity is. And because, as I said to you before we started recording, food is medicine. Food is also poison. It's about the food choices you're making and the quality of that food. You know, food is driving chronic disease and food can prevent chronic disease. It's both sides of that are true. And we have to take responsibility. You know, and I challenge my colleagues in the medically tailored meal space who are always throwing around food is medicine and frankly some of them are still serving margarine I mean it's like And they talk about quality. I'm like, we've got to talk about what we mean when we use the word quality. It's not just the nutrients in that meal for us. Like I love healthcare without harms, environmental nutrition framework, which is nutrition has to mean the health of the whole system, not just the nutrition in the food. And as you know, the nutrition in the soil also drives the nutrition in the food. Like all carrots are not created equal. So it all matters. And I think partly the conversations have happened in such, like little arcs of the circle, but not the whole circle at once. And that's what I think the opportunity is. And for everyone to understand that we have to be advocates for all of it. We can't just be advocates for part of it. Like if you care about all this and you're a regenerative farmer to understand what's driving hunger and how hunger is being solved in your community and finding a way to be part of that solution and doing it in a way.

SPEAKER_00: 35:00

Which might not be the farmer's market or your current sales channels.

SPEAKER_01: 35:04

Right. The farmer's market and having a discounted CSA box, becoming a SNAP authorized retailer and offering a discount for low income people to buy your bottle. Like there's some, you know, connecting with your local hospital and saying, could we have a farmer's market here? Or the USDA now is funding produce prescription models, right? It's called the Gusnip program, Gus Schumacher Nutrition Center program. There's a lot of dollars available for people to develop produce prescription models with their local community health centers. And then bringing really high quality food to that and building those reimbursement mechanisms. Like there's a lot of solutions in there.

SPEAKER_00: 35:42

So basically the biggest impact I'm realizing now took an hour, obviously of nutrient dense food or food as medicine is, is obviously with the people that are not near that at all at the moment. Like if you are on a fast food diet coming out of a hospital because of very serious illness, that's where it hits the hardest. Like if you then go on 12 weeks of super organic super tasty low in salt low in everything that you don't need and high in everything you do need that's the biggest potential benefit it's not for the people that already go to the farmer's market and might switch from some organic to deep soil building that's a very marginal it's an interesting improvement we see the differences in carrots etc but it's not where the biggest impact lies the biggest impact lies on the other side of the equation where the normal meal is mcdonald's

SPEAKER_01: 36:32

yeah thank you for saying that i mean it's interesting because i am part of the food lab at Google. And there's a lot of conversation there about personalized medicine and like all these kinds of things. And I'm really interested in, you know, the 30% of Americans that can't access a basically healthy diet. I mean, that's what's driving chronic disease. And when you look at an equity standpoint, that's where we need to be focusing. That's why we're really interested in making change in the Medicaid system, frankly, because that's the population that has the highest chronic disease burden, has the least access. And I feel really strongly that we need to focus there. And that's where we can make the biggest difference. So I appreciate you pointing that out. And it's about bringing, you know, organic shouldn't like there's, you know, there's always been a conversation for years about organic being elitist and more expensive. It's like

SPEAKER_00: 37:18

whole paycheck.

SPEAKER_01: 37:19

Organic needs to be for everyone. And we need to make it. It's got to be it's got to be a commitment to the highest quality food for every American, not just for the people who can afford it. And that's why driving change in health care policy is so important, because we can radically expand access to very healthy food because healthcare has so many dollars to spend. And there's already so much evidence that investing in food can drive improved outcomes and save costs. So it's a win, win, win, win, win, win.

SPEAKER_00: 37:50

Yeah. I don't remember the exact data. I think it used to be American spent 18%, one eight on food and 9% or so on healthcare. And it's switched completely in the last, I'm saying 20, 30 years. I don't remember the exact date, but now it's 18 and nine the other way around. And yeah, Yeah, we see the results of that. Let's say I want to be conscious of your time. I know you have another call to go to. I have one last question. If you could wave a magic wand and you have one thing, I feel like we just started discussion, but we'll come back another time. If you could wave a magic wand and have one thing change in the food and egg space, what would that be?

SPEAKER_01: 38:21

I mean, for me, the driver is that Medicaid was covering food, that everyone with chronic disease was getting a food prescription, like from pre-diabetes or kids with obesity all the way through people who are being hospitalized I

SPEAKER_00: 38:35

imagine healthy

SPEAKER_01: 38:38

food, not just general food.

SPEAKER_00: 39:04

Somebody is picking up the bill. That's probably three, four times over, maybe 10 times over. But at the moment, that little price tag seems very cheap and it's not. It's poison in many cases. I think that's a very strong way of, and a very good way of ending this conversation. I want to thank you, Catherine, so much for your time. I know you have a very busy schedule and I think, at least I, but I'm pretty sure most of the listeners learned a lot about a side of the food system we hardly ever talk to, but it's extremely and extremely important and underfunded and underinvested and underworked at under unfortunately because it's such a there's so many wins to to win there basically

SPEAKER_01: 39:39

thank you so much it was a real pleasure and i look forward to continuing the conversation at some point

SPEAKER_00: 39:43

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