Tag Archive | health disparities

Far from Home

Well here I am. Right now I am on retreat in beautiful California, far from home. While my orientation to space is altered due to this coastal exchange from east to west, my orientation to date and time has been altered as well. I have experienced a profound loss.  image

As I search for some renewed serenity and some solid ground-albeit in this land of shaky earth-I do try to stay somewhat aware of the prevailing events of these times that still swirl around me. Likewise, as I reconnect with the calendar structure that patterns the days before me, I turn the page onto August just in time to remember to honor the annual celebration of World Breastfeeding Week.

In that I consider the support of breastfeeding babes, moms and families an essential component of improving the collective health of communities around the globe, I do always try to write something about World Breastfeeding Week and its annually appointed theme.

Forgive me this year, that as my tears still flow more readily than my words, in lieu of my own thoughts I share this interesting article by journalist Ellen Wulfhorst who I am grateful to call my dear friend. Ellen provides a look at the very real consequences of compromised attention to the timely initiation of breastfeeding. This highlights how powerful are the immunoprotective properties of breast milk and how greatly breastfeeding serves as an antidote to infant mortality.

Thank you to all of you who continue to support me, my blog and my work. Gratitude to those who have nourished me so wonderfully on this visit–Julie, Gordon, Debbie, Michael, Ben, Lois and Richard. (Check out Lois and Richard’s creative and funny political satire webisode series Medicare Mermaids at http://www.medicaremermaids.com)

To healthy birth and rebirth, Elyn

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Julie’s MyPlate

MyPlate Food for Thought. Breastfeeding is not only the cornerstone of a child’s healthy development; it is also the foundation of a country’s development. UNICEF and World Health Organization’s World Breastfeeding Week Message

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meditation v medication march madness rerun

This is a slight revision of one of my earliest posts.   I present this older one while I am busy meditating this week on matters such as the recent break through news about saturated fats and heart disease; 24/7 automated cupcake dispensaries; and, the myriad of nutritional dilemmas that cross my path daily.  

Once upon a time, I was walking down the hall of the Health Center. Passing a closed exam room, I heard the doctor who was inside with a patient say, “Here’s a meditation for you”.  Ah, meditation. Instantaneously, I felt my spine lengthen, my breath deepen and my third eye got a nice little buzz.

Anne-Marie’s eggs

But wait. Which of the Young Living Essential Oils that I frequently use had I just inhaled? Was it the oil blend Hope or Dreamcatcher? I must have been hoping or dreaming. By the time my foot that was in back had overstepped the other one and placed itself in front on the cold, hard and very clean commercial tile, I realized she hadn’t said meditation. She said medication. Of course, silly of me. Where did I think i was?

I must digress for a moment.  The floors in the Health Center are incredibly shiny.  Everyday, they are cleaned in Zen-like fashion by a woman named Pam.  After dancing with the waxing machine,  she traces every seam with a long stick with a tennis ball attached to the end, and then with tiny little tools she meticulously erases every scuff mark with the hands of a surgeon.  The place glistens.

Perhaps my momentary delusion was fueled by the fact that the night before I had seen this amazing film called, May I Be Frank.  It is the true tale of transformation on the physical, emotional and spiritual planes of an overweight, lonely, ill, middle-aged ex-addict named Frank, living in San Francisco.  His soul yearning unexpectedly leads him into a raw food restaurant named Cafe Gratitude and the story begins. Through the use of whole foods, affirmations, holistic health modalities, and the receiving of love, true and profound healing ensues. In the film, there is a scene where he goes to a massage therapist. The massage unleashes a deep emotional release in Frank that simultaneously relieves his chronic back pain. I noticed that on the table in the massage room was a collection of Young Living Essential Oils that I am sure were used.  I tell you, these oils are powerful.

How many times a day is the word medication used in the Health Center?  I even say it about eleven times — and  I am mainly talking about green beans and sardines. Venturing a guess–seven hundred and nine times. No, I don’t think I am exaggerating. If anything, I am underestimating.  There is a lot of medication going down.  (Just today I saw a statistic that said 70% of Americans are on at least one prescription medication.)

Imagine if we could subliminally say meditation instead of medication this many times. What meditation are you taking? I am going to prescribe you some meditation. What’s that? You are calling for a refill on your meditation? Which one? You can pick it up at the sanctuary–along with your wheat grass. That would simply and certainly alter the medical paradigm.

We would do well to consider our health facilities more so like holy temples with acolytes arriving for sustenance and to promote meditation as a veritable ally in the healing of ills.  Though the practice of integrative medicine is growing in acceptance and availability–my yearning is to see it accessible and as a model of care–particularly in high risk communities. This film is one of many these days that provide witness to inspiration, possibility and even necessity.  Pam’s devotion to her task has prepared the sacred ground.  When the time comes, may we be ready.

In health, Elyn

In honor of the egg–its promise of rebirth, its seasonal symbolic representations and its role as an example of dietary dithering–for the month of April I will gladly accept submissions of MyPlate Eggs of your own inspiration.  Thanks to my multi-talented friend Anne-Marie for her beautiful  Ukranian pysanky eggs.  Please submit in comments or at zimcat@verizon.net).

IMG_0612

Emma’s My Egg

 

My Plate Haikus

The farmers’ market/Each egg at the dairy stand/A different color.  by Enki

Food made joyfully/As a gift of time and self/Feeds body and soul.  by Anne-Marie

inventive incentive

To make bread or give love, to dig in the earth, to feed an animal or cook for a stranger—these activities require no extensive commentary, no lucid theology. All they require is someone willing to bend, reach, chop, stir. Most of these tasks are so full of pleasure that there is no need to complicate things by calling them holy. And yet these are the same activities that change lives, sometimes all at once and sometimes more slowly, the way dripping water changes stone. In a world where faith is often construed as a way of thinking, bodily practices remind the willing that faith is a way of life.

Barbara Brown Taylor ~ (An Altar in the World: A Geography of Faith)

On a cloudy and dreary Saturday morning in October, I headed into Albany to catch up with the ever busy Veggie Mobile in order to get a glimpse of the Veggie Rx Program in action. It had been almost two years since I began administering this program that I had helped establish at the Health Center, and as a concerned mom, it was time for a periodic check-up to see how it was doing.       

Veggie Rx is a “prescription incentive” wherein fruits and vegetables are “prescribed” to medically high-risk patients by their health care providers as a means to encourage healthier diets and to improve health outcomes. Similar programs have begun to emerge in the past few years, and are being considered as a model of a viable public health intervention for disenfranchised communities. This medically-housed approach provides powerful messaging, unique for an institution that traditionally proffers mainly pharmaceutical solutions and well-meaning but often weak recommendations for health behavior change. It affirms, “Let food be thy medicine.” 

Veggie Rx was initiated as a collaboration between Capital District Community Gardens (CDCG)* and the Whitney Young Health Center and is funded by the NYS Department of Health’s Hunger Prevention and Nutrition Assistance Program. It was designed as a pilot to serve fifty persons with diabetes and/or hypertension. Once recruited and enrolled, the participants receive “prescription coupons” valued at $7** each, which can be redeemed once per week on CDCG’s Veggie Mobile. This bio-diesel fueled, hip-hop pulsing, “produce aisle on wheels”, toodles around many Capital District neighborhoods most days of the week, year round. It irrigates identified food deserts by arriving at a variety of community locations where anyone can shop, right on the truck. It is somewhat akin to an ice cream truck except that it hawks an impressive array of fresh fruits and vegetables, much of it from local farms. 

I met up with the Veggie Mobile that day in the city’s Arbor Hill neighborhood. Parked at the corner of a side street, it was a burst of color in a rather gray landscape. That brightly painted truck always shows up representing the rainbow, but it is the activity that it fosters that is the pot of gold. Among the customers were two Veggie Rx participants. One was a woman whom I had just enrolled in the program. She was there with her two young granddaughters. ‘Patient with diabetes’ instantly transformed into ‘loving grandma’ as I watched her solicit the girls’ advice for what to choose that week. The other was a gentleman whom had been enrolled for a while but who had not really participated. I had recently called him to discuss removing him from the program—but he asked for another chance. He explained that he had experienced a host of health problems but was feeling better and really wanted to have this opportunity to improve his diet. Sure enough, there he was like a kid in a candy shop–but instead of candy he was purchasing a sophisticated assortment of produce.

After an hour at that location, the dedicated Veggie Mobile staff women closed up shop. I hopped in my car and followed them as they got back on and off the highway and made their way over to the next scheduled stop at a low-income housing complex—not too far from the Governor’s Mansion. Arriving there, about fifteen people were already waiting–men, women and children–including two more Veggie Rx participants. They were surprised to see me and greeted me with smiles and hugs.

This was a busy site, so I assisted with bagging while anchoring myself at a good vantage point. Shopping on the Veggie Mobile begs some patience—but perhaps not any more than waiting in a fast food drive-thru line. Here though, was connection, community and lots of conversation about good food. There was squeezing back and forth as people reached to add another sweet potato, banana or onion to their order. All forms of “monetary green” (cash, SNAP EBT cards, New York State Fresh Connect and Farmer’s Market Coupons–along with the cute Veggie Rx coupons) were exchanged for “nutritional green” (collards, kale, green beans, green peppers and broccoli). It was a beautiful sight to behold.

Despite my sheer love of this program, I am still not sure if these incentive initiatives are token, feel-good, short-term experiments–or the templates for a new health and food revolution. Are they worth the effort for the few that they serve? Can they put even the tiniest dent in the massive problem they are trying to solve and might a few fruits and vegetables a week really affect change?

What I  do know is that I have seen Veggie Rx change the behaviors and well-being of many of those in the program. Let me strengthen that. I have witnessed some profound changes. There has definitely been some powerful “medicine” going down. Participants have started juicing, making smoothies, and taken to more plant-based diets. Many have attested to feeling better and have noticeably become more enlivened. While I have also noted improvements in individuals’ health markers (weight, blood pressure, hemoglobin A1c)–to see these markers shift in a significant way for this highly challenged population will take time. I caution not to base the success of these types of programs solely on those indicators–it is too myopic a lens.

Veggie Rx offers more than just food access and is about something greater than fruit and vegetable intake. Relationship building is the true foundation of this program. This power of relationship–between participants and the Health Center and Veggie Mobile staff–is not to be underestimated. Having undertaken an evaluation of this program and through my direct contact with the participants, I know that they feel better valued as both patients and consumers which increases their engagement in both roles. I also know that they consider this program to be a blessing in their lives–those are their words, not mine.

Participation comes with some requirements which asks something deeper of its recipients–like standing out on street corners in the cold, shopping in cramped quarters, finding a specific time and place to shop, and committing to follow-up medical appointments. Not everyone enrolled has taken advantage of the program, but the majority have–and some quite extensively.

As a metaphor for, or a substitute expression of the universal yearning to return to the land, the capacity to access the bounty of the earth perhaps subconsciously reminds us of the connection to our source and our birthright of health. The mere act of showing up and filling one’s bag with beautiful produce yielded from the soil, reflects a powerful commitment to one’s self. Standing witness on that morning shed light on what a new paradigm of health care could look like–particularly in response to the problems associated with health disparities–but in the larger context as well. I returned home with a reassurance that my little toddler-aged program was doing well. I can’t wait to see it grow.

As always, greetings, thoughts, and inspiration welcomed.

In health, Elyn

*Capital District Community Gardens is now known as Capital Roots.

**An additional food bag valued at $4 is also provided as part of the Veggie Mobile’s Taste and Take tasting program. So,Veggie Rx participants receive $11 worth of fresh produce per redemption.

Related Articles:

Food Trust/Policy Link:  Access to Healthy Food and Why it Matters

Double Value Coupon Program–Diet and Shopping Behavior Study

Building Healthy Communities Through Equitable Food Access

my plate

my plate

My Plate Haiku

Food is medicine

Farmers are doctors, Cooks priests

Eat, pray, eat, pray, love.  By Gordon

the new food revolution, food stamp cuts and health disparities

My Dilemma cuddled up next to me in bed and rested its head on my shoulder. “What is coconut palm sugar?”, it asked. I explained tenderly while rubbing its dear little head, that it is a natural product made from the nectar of the coconut palm tree. There are several different varieties of palm, and “coconut palm” specifically refers to the coco nucifera plant. It possesses a low glycemic index making it a healthier choice than sugar refined from sugar cane or beet sugar and an option for diabetics. My Dilemma looked at me with the pure innocent eyes of a child.

English: Coconut Palm tree on the beach in Nus...

English: Coconut Palm tree on the beach in Nusa Dua Bali Indonesia (Photo credit: Wikipedia)

“And what about goat’s milk kefir?”, it then asked. I answered, “Oh, you know. Kefir is a fermented milk product that originated centuries ago in the Caucasus mountains, made from the milk of any ruminant animal–in this case, goat. The various types of beneficial microbiota contained in kefir make it one of the most potent probiotic foods available.”

I thought it might be drifting off to sleep, but then it muttered, “Can you tell me the story about chia and hemp seeds,  lukuma, stevia and mesquite sweeteners, oh and kombucha and cacao nibs?”. Try saying kombucha and cacao nibs five times fast. Wait a minute. Looking its way, I noticed a little smirk on its face.

I realized then it must have been looking through some of my papers that I have lying around among all of my resources. It was getting late and I was not in the mood to be playing games–even the one apparently called, describe the recently sourced foods deemed essential to a really healthy diet and that are alternatives to the substances compromising our health. Really, it is getting hard to keep up with these emerging products. I could have been annoyed but instead just planted a kiss on its little cheek. Besides, my Dilemma is always incredibly patient with me as I stagger about waving my sword attempting to slay the conundrums of our modern world’s feeding debacle. It is essentially the Sancho Panza to my Don Quixote–forever loyal.

I plumped the pillow, pulled up the covers and made sure it was quite comfy. It puffed a little sigh, the kind that signals the final controlled exhale of the day, but then it managed one last exertion. “Do you tell your patients at the health center to eat these foods?”  I remained still and didn’t say anything. I knew if I ignored it, sleep would blanket its cares and it would choose dreams over reality drenched answers.

I was glad to lay the matter to rest and tucked myself in for the night. But still, I knew my innocent-seeming Dilemma was playing me. It knows that everyday as I walk into my office, I pray that I may not alienate my clients by making totally unrealistic suggestions, and that I am grateful as I leave that there is still air in my tires. It is quite aware that I oft apologize when I utter things like, extra virgin olive oil, stevia, quinoa, almonds, and organic milk. It knows I choke and can hardly ever say grass-fed, locally raised beef and heirloom tomatoes, and that I break out in hives when considering presenting the advantages of a gluten-free diet for certain individuals.

My economic assessments must be made fast and furiously and I cannot instantaneously calculate what a person’s monthly social security income, low wage earnings and varying food stamp dollar allotment translates into in terms of a daily food budget for themselves and their family. Many of my clients depend on the graces of food pantries–especially at the end of the month; some live in shelters or at rehabilitation centers with absolutely no control of their food choices. If quizzed, I would say the majority of my patients know the price, more or less, of white rice, corn or vegetable oil, hamburger meat, chicken and twelve-packs of soda–and messing with their math by offering well-meaning alternatives does not make for good calculus. Though food budgeting education is valuable, most whom I work with are already experts in that regard. I can’t surmise how much wiggle room someone has in order to make their diet more of a priority, but I must venture in and gather and glean some sense in order to gauge what is possible. At the end of the day, I can only hope that I was close, if there is to be any hope of meaningfully promoting diet for health.

A shelf in my office contains food boxes and wrappers, non-perishable examples of “consider this” and “please, whatever you do, try to avoid this” foods. The shelf is not big enough. My patients are kind as they pick up from the floor the items that have fallen as I search for something from my display to show them.  For those with grass-fed dreams but ground beef budgets I have a few things to suggest, though I lament that it is nary enough. These include:  beans, oats, sardines, milk substitutes, flax seeds, teas, lemon juice, spices, dried apples, low-sodium chicken broth, canned salmon, whole grain pasta, boxed tomato sauce, sunflower seeds and apple cider vinegar. When I can, I offer little samples. On some days I have coupons for the farmer’s markets, the local food coop and manufacturer’s products to share-and I do have a small group of patients tucked under my wing participating in a program that provides free fruits and vegetables on a weekly basis.

Almost everyone is thoughtful, attentive and appreciative and willing to try to do something. Hardly anyone looks at me and yells, “Are you kidding me?” as I proffer a baggie of cinnamon. Still, I need a lot more to ameliorate the consequences of the nutritional junk yard that litters the land and to which those living in poverty are most vulnerable. With sugar at 62 cents a pound and coconut palm sugar going for about $5 for that same amount, what I could really use is a more level playing field if I am going to accomplish my goal of minimizing health disparities.

In the morning, I found my Dilemma curled up on the couch with a cup of coconut palm sugar sweetened  teeccino caffeine-free herbal coffee alternative and the newspaper.  “Good morning”, it greeted me. “Just reading about the cuts to the food stamp program.”  “Have a good day!”, it shouted after me, as I ran out the door to work.

If you have any suggestions or would like to hear what I think my patients could really benefit from, drop me a line.

Remember, you can follow my blog by simply subscribing here. My Plate haikus and photos always welcome.

In health, Elyn

Important Postscript:  Please take a moment to watch this beautiful video, Place Matters, by Clint Smith

erin's plate

erin’s plate

My Plate Haiku

Hunger tiptoes in

From bellies, hearts or minds

Feed me now she calls.

By Eva

reporting from the rim of the sinkhole

At about 4 PM, a few months ago, Pete sent me an email saying something about soul food. I was rushing to end my day so I overlooked the attachment that would have filled me in on the details and why he thought this might be of interest to me. I dismissed the message quickly.

That evening though as fate would have it, I got another message on my email informing me that I had a new follower on Twitter.  This was big news given that it is a rare occurrence. As Pete assures me that I am right behind Lady Gaga in terms of followers, I must assume that she might have like twenty-eight. So, I decided to check out my ignored little bird account and see who my new follower might be. Once there, I stumbled upon a flurry of activity on the feed from someone I follow–chef and food activist Bryant Terry, author of Vegan Soul Kitchen and Urban Grub. The excited conversation was about a PBS documentary Soul Food Junkies which was apparently being aired right then. The praise was pouring in for this film by Byron Hurt, about his exploration of the historical and cultural roots of soul food cuisine and its relationship to the current health crisis with its impact on the African-American community.  

Ah, now I got it. I ran upstairs to the TV room and grappled with the remote. Mastering its controls I pushed that channel button frantically. I must mention that I have about as limited a relationship with the television as I do with my Twitter account–and relying on an old antenna like apparatus, have access to about seven channels. Still, I knew I did get PBS. Round and round I cycled through those seven channels, three PBS stations and still could not find the show I was looking for. It seems PBS offers a few different channels these days, and I don’t get the one on which the program was aired. Instead, what I did find on was a program about a guinea worm eradication program sponsored by Jimmy Carter’s Carter Center in Africa. It was rather fascinating though quite gruesome to watch. Apparently, water-borne guinea worm disease which has plagued a wide swath of Africa and Asia for thousands of years is poised to be eradicated. In 1986 when the Carter Center began its campaign with the partner countries, there were an estimated 3.5 million cases in 21 countries. By 2012 there were 542 cases left in just four African countries.

Guinea worm disease is contracted from ingesting drinking water contaminated with larvae that once inside the human abdomen grow into worms up to three feet long.  These worms eventually emerge from the body through excruciatingly painful blisters on the skin. I guardedly watched as health workers painstakingly exorcised these worms from the legs of screaming children and stoic adults, wrapping the worms around little sticks which were slowly turned. One worm, one person at a time. The success of this amazing eradication program has been due to water treatment and filtration programs and community education at a very grass-roots level.

A few days later I was able to watch Soul Food Junkies on pbs.org. It is an excellent film and I have been talking it up with a lot of my clients–and others as well. Many of my clients are African-American and my daily consults revolve around discussing this interface between food as cultural identity and health. Soul food is not the only problem area. Many cultural cuisines that have sustained people for millenia are causing problems in the context of our modern existence. This is due to various reasons including agricultural alterations in the actual foodstuffs that form the basis of these cuisines, more processed versions of these dietary staples being substituted for the real foods, traditional diets being padded with the excess of sugars, concentrated carbohydrates and other addictive substances that infiltrate our beings and a massive increase in sedentary lifestyles and stress. The vulnerable communities that are more exposed to poverty and its attendant health disparities are experiencing greater discord between their food and their health.

This is multi-layered stuff that claws at the core of who we are as eaters and which reveals how deeply connected we are to our heritage. Food is clearly not just extrinsic matter. It communicates intimately with our cellular makeup. And, it is a heavenly sacrament. I remember as a child listening to my mother and my aunties trying to sever the relationship between my hypertensive grandfather and the heavily salt-cured foods of his Russian roots. Little did I know I would one day be standing between an African-American man and his beloved fried chicken or an Asian woman and her dear little grains of rice.

But yes, there I am. Standing tall at five feet one, holding firm with my big professional tweezers before every diabetic who sits in my office. With exact precision, I try to extract each granule of sugar  that has gone rogue in the bloodstream, wreaking havoc on the body–sort of like a guinea worm. Just as guinea worm disease takes hold in unsuspecting individuals so does diabetes. Persons consuming available foods for the  purpose of sustaining survival and attaining some pleasure, awaken one day to learn that they are infested with massive globs of excess glucose.

I have been doing this work for a long time and I can tell you that the diabetic epidemic is getting worse. My daily roster is full of newly diagnosed cases of diabetes. This morning I woke up to some crazy NPR story about the woes of candy makers due to the relative high price of sugar–the price regulated by the Farm Bill. Apparently, the makers of Dum Dum lollipops require 100,000 pounds of sugar for the daily manufacture of ten million Dum Dums–and they are having a hard time affording it. Can those numbers be for real?  Well, please don’t tell Dum Dum  that I have some sugar stockpiled in my office–mounds of the stuff that I have removed from my clients. I know they will just try to recycle it right back into the very folk I took it from.

Diabetes might not seem to be as bad as guinea worm–but one can actually make many metaphorical if not actual comparisons. Diabetes leaves many physical and emotional scars. My clients look at me through eyes that plead to spare them from this scary disease–that comes complete with implements that stab and jab and symptoms that pain and worry–depleting the soul. I scurry furiously to help pull them out of the sinkhole of this very complicated condition. If a disease caused by a swarm of microscopic larvae can be eradicated from the planet, it is hard to believe we can’t do better to minimize the incidence or increase the reversal of diabetes.  The methods employed essentially would seem to be the same–clean food, governmental responsibility, education and cultural adaptation.

And so, that is why the work of Bryant Terry and the film of Byron Hurt is so important–and why folk should watch Soul Food Junkies and align it with their own food foundation. And, why you should quickly sign on to the Food Summit Revolution 2013--a series of incredible interviews on these urgent food and health matters that will be aired between April 27th and May 5th.  Time is of the essence and Jimmy Carter deserves a rest.

Thank you for reading, really. As always, thoughts, tweezers and twitter followers welcomed.

In health, Elyn

My Plate Haiku

Food made joyfully

As a gift of time and self

Feeds body and soul.

by Anne-Marie

My Plate Photo by Nirinjan

of poverty and light

Amid all of the celebrations of the holiday season it sure is easy to over indulge and to gain those few–oh excuse me for a moment–my dilemma is tugging at my sleeve. Sorry, it seems to be interrupting me to say something about property. Property? Puberty? You know, despite its omnipresence in my life, I often don’t even understand my own dilemma sometimes.

It is like when my son was little and (prematurely) learning to talk, he would get so frustrated when his word was misinterpreted. When I would repeat the statement to make sure I had heard it correctly, like, “You want some bed?”,  he could only surmise that his mother must be severely limited and he would implore the heavens for some relief. Who on earth he would beg says, “I want some bed” and even if they did, why would they say that when standing in the kitchen after nap time? What part of “bread” does my mother not get?027

My dilemma is reacting the same way now. So, with a deep breath, I will take its sweet little face between my hands and ask it to calm down and try to tell me again. Oh, I get it now. Poverty. My dilemma is asking me if I could please not write about holiday eating, but instead about poverty

Oh, poverty. “Right now?” I ask, in the midst of this season of tinsel-tinged holiday cheer?  Yes, it replies. Write about it on this darkest day of the year when we most crave the light to illuminate all that should be revealed. “Can you just try?” it says in that adorable little voice. “About poverty and nutrition?”

What do I know about this topic and what credentials do I have to write about it? Well, I do work in a Health Center that serves the economically poor–the uninsured, the under insured, those whom sit at the bottom of the economic ladder, those lacking in many of the resources that others easily possess. And, I do educate on nutrition. Yet, I am still nervous to presume that I have the right to tread here. My own perceptions are actually a bit blurry. Though every day I am deeply privileged to have my clients share the stories–somewhat intimate–of some parts of the realities of their lives, I cannot claim to really know what their impoverishment feels like. And, though yes, the majority of my clients are poor, some poorer than others–they all mainly go to sleep with some roof over their head and some food in their tummies–even the homeless ones. Furthermore, they possess a richness that nourishes and inspires me as well–whether it be of spirit, honesty, feeling, fortitude, resilience, wisdom, story-telling, family and community connection, self-reflection, humility or appreciation.

Yet, I am still perplexed, so I look back at my dilemma and ask, “But, don’t people already know about poverty and nutrition? That it is complicated but it has something to do with the cheapest (hunger slaying) food often being the least healthy; the battered economy; governmental food subsidies; food deserts; reliance on convenience and processed foods; income inequality; the history of supplemental and commodity food programs and the lack of a just and sustainable food program? And, haven’t I already discussed things like food addiction and the impact of excessive sugar sweetened beverages on emotional and physical health? And, I probably have already ranted about even bigger, more amorphous issues like lack of breastfeeding, TV advertising, health disparities, a stress-based society and may I now even add environmental toxins and gun violence which disproportionately affects our poorer neighborhoods–and how I believe all these things affect our bodies and who we are as eaters.

My dilemma nods and whispers, “Well, is there anything else you’d like to add?”  I sigh. Maybe it is on to something. There are many disparaging assumptions made regarding how the poor feed themselves. Maybe what I can do for today is to shed some light on how poverty in modern-day America infringes upon the hunting, gathering, and metabolic fundamentals required for normal human nutrition–a process that has become quite enigmatic for many, but more profoundly for those who must often do with very limited resources. In the daily conversations that I have about this elusive, ill-defined quest for proper eating–oft imagined as being as simple to prescribe as popping a pill–I am perpetually filtering many realities that are probably rather obscure.

So, here it is. Most of my clients would like to eat better. They would–but there are numerous hindrances. Many are tired. Very tired. Those who work, often work very exhausting types of jobs. Many of them–the home health aides, the certified nursing assistants, the truck drivers, the cleaners, the warehouse stockers and even the retail workers–work variable hours, often with overnight shifts which distress the natural circadian rhythms and thereby the sleep and eating patterns. Those who don’t work are often depressed or in chronic pain. Food provides easy relief. They live in neighborhoods where people get shot and murdered. They forget how to use and move their bodies. Many over their lifetimes have cared for so many others that self-care is just an amusing oxymoron. Often, just the physical requirements that cooking entails become difficult.

Additionally, when money is tight for food, so commonly it is for all the things associated with food preparation and eating. This includes appliances like stoves, ovens, dishwashers, refrigerators and freezers–and even the kitchen table and chairs. Some of my clients live in accommodations where not all of these are provided or where they are not properly working. Some only have a microwave to cook their food. Some live in settings where they have to share a kitchen with random roommates. Some people keep food in their bedrooms to prevent others from eating it. Those who live in group programs have no control over the type of food that is provided.

And, then there are the even smaller things like a set of good knives, measuring cups and spoons, pots and pans, a blender, a cutting board, a steamer or a food processor. For many a modern cook, one could not imagine even basic food preparation without most of these accouterments, if not even more. Yet, for some these are downright luxuries. Just recently, I did a display on winter squashes to promote these nutritionally blessed, fiber-dense and delicious denizens of the food kingdom–but even so, I was cognizant that unless one buys them pre-cut and frozen these pretty gourds demand a whack of a proper, well-sharpened knife to reveal their inner gifts.

Each person has their own circumstances. Though I must serve my clients quickly and effectively I have to obtain some information before I venture in with suggestions. I cannot assess for all of the above. I must pry for information with the utmost gentleness and respect to get a quick sense of where we are starting from. Depending on the person, sometimes it is obvious, sometimes not. The foods that are now commonly touted to be required for a healthy diet, I sometimes must ask permission to utter. I say things like olive oil, brown rice, walnuts, almond milk, and on a good day, quinoa, preceded by “may I?” and followed by “thank-you.” What might seem like a mole hill of a price differential could quite truly be a mountain.

Thankfully, there is usually space for an appropriate conversation about food and eating when the context is understood and appreciated. And, fortunately too, the realm of health-giving foods contains some low-cost and readily available options. My clients are glad to be reminded of them. Usually, they learned of them from their grandmothers as well. But, most importantly is when that light goes on that says that they are worthy of nourishing themselves in the best way that they possibly can. That they matter. Then this abstract matter of nutrition  begins to make some sense.

So, I guess, my main observation is that bottom line, despite our economic differences, we are first most eaters–doing the best we can with what we know and what we have in the moment. And, that somewhere, somehow, it is always about love. I look back at my dilemma for some confirmation. Oh well. It has fallen fast asleep.

Please share your thoughts and comments. I welcome your feedback.

Read below on the new My Plate Invitational

Blessings and light.

In health, Elyn

http://the2x2project.org/health-gap-wealth-gap/

my plate

my plate

My Plate: In honor of the New Year, I invite you to submit a photo of your own beautiful plate to be placed in rotation along with the My Plate Haikus. My My Plate is the prettier template and more personal representation of the My Plate put forth by the USDA as a model of how Americans should feed themselves–which replaced the food pyramid. I can’t wait to see yours. It can portray whatever nourishment, proper eating, or mealtime means to you. Haikus always welcome too. Thank you.

You may include it in a comment or submit to zimmermanelyn7@gmail.com/Subject Line: My Plate Photo

she weighs how much?

I present this as a Zen Koan. A Koan is a paradoxical question, the meaning of which cannot be understood by rational thinking. It derives from the Japanese words “ko” for public and “an” for matter for thought. This is clearly a public matter for thought in the current dialogue on childhood obesity. How do we best serve a seven-year-old girl whose high weight highly challenges notions of normal growth patterns?

This girl is not a nameless theoretical child. Tanazia is an amazing girl who I know. She has keen inquisitive abilities, deep empathy for others, and sophisticated insight for someone so young. She is deeply connected to her family, respects her elders, and helps care for her three-year-old brother and emotionally reactive two-year-old foster-sister who she shares a room with. She excitedly tells me that when she grows up she would like to do something to help others. When her grandmother mentions the Peace Corps, she responds that there are people right here in her own community who are in need.

Tanazia—who is just one of many children who are accumulating weight in an inconceivable short amount of time–is in a relatively good situation. She now lives with a set of very caring grandparents who love her dearly. She has a stable roof over head, and there is a modicum of food security. While some family members are overweight, her grandmother, who had gastric bypass surgery a few years ago, is generally food savvy and keeps a relatively healthy home. Plus, she has a back yard–one large enough and safe enough to play in—a rare commodity in this part of the city.

Despite this, she has already had to armor her body with layers of body fat against many emotional wounds. She was born to a 15-year-old mother who has since had two more babies and is now pregnant again. Her father has died, and she was at an early age exposed to and a victim of domestic violence. Her grandmother has chronic health problems. And, she herself, has asthma–another player in the childhood obesity conundrum. Her mom has supervised custody and gets to see her daughter every other Saturday for just a few hours. Equipped with few ways to show her love, during their time together she usually takes Tanazia out to eat somewhere. It’s usually Chinese food or pizza with soda and candy.

This sweet child has already endured the taunts of kids. Going to school-squeezed into her charter school uniform skirt—is something she is already leery of by second grade. Though her grandma does give her breakfast at home and provides her with lunches to bring to school, controlling the intake at school is hard to do. Unfortunately, the meals provided by the school lunch programs do not meet nutritional recommendations and are a sad source of the low quality foods and excessive fats, sugars and calories that are contributing to the problem. Turning down a free meal or two in a day would be hard for anyone to do, especially for those to whom the secure availability of food is not a given.

Declining the morsels of joy to be found in the cheap junk foods that easily find their way into all the cracks and crevices of our lives–cupcakes, bags of chips, rice krispie treats, fruit punch– is nearly impossible for those with easy and happy lives let alone for those who excessively use food as an easy and legal pursuit to push down painful life experiences.

And, although Tanazia has a backyard, the physical activity levels of young girls who live in vulnerable neighborhoods are amongst the most limited. Add in the cold winters in this part of the country and the possibility of expending calories diminishes even more.

Despite these challenges, this beautiful child tries hard to do what I—her nutritionist—have recommended. She drinks mainly water, she listens to her belly to see if it is really hungry—a task most adults find hard to do– and has only a small piece of cake at birthday parties and church functions.

My heart breaks at having to impose such harsh restrictions on such a young life. I know restriction breeds hunger. I know parental strategies require fortitude, patience, non-judgment and structure. I don’t have many options nor enough solutions to fight all the forces that prey upon this innocent child and countless others like her. Current anti-obesity initiatives come far too late and offer little. Cute and catchy names of new programs belie the gravity of the situation and chew at my cynical side—the part of me who knows too many stories of real children’s lives. Societal weight stigmatization adds to the burden. I pray for this young girl to grow up healthy and whole, equipped with all she needs to be a powerful adult. Hopefully, size alone will not get in her way.

In health, Elyn