The Ionia County Health Department is located in Ionia, Michigan, serving a population of approximately 63,000. The population is 92% caucasian, and 11.5 percent live at or below the poverty line. The Ionia County Health Department has robust WIC and Maternal-Infant Health programs. These programs are both income-eligible. 

It became apparent to our staff prior to the COVID-19 crisis that food insecurity, already an issue with this population, was becoming worse. This problem was further exacerbated by the crisis. The goal of this new project was to address that food insecurity by opening a food pantry at the Health Department to conveniently provide healthy food to families who use our programs. Howeover, the roll-out of the program was negatively impacted by the crisis, forcing us to make modifications.

Ahead of COVID, we had initiated a new practice of food distribution by forming partnerships with local and regional food organizations to open a pantry at the Health Department, purchasing food through the use of grant funds. We had initially planned to focus on fresh fruits and vegetables, items often missing from the regular diet of low income families.

We ran into several obstacles brought on by COVID. First, a funding shortage meant that we could not purchase refrigeration equipment to store fresh food. Next, office and home visits were curtailed by protective protocols during the pandemic. We switched to telehealth, limiting our distribution window.

To meet our objectives, we adapted. We switched our focus to shelf-stable fruits and vegetables. We also set up a different system to get the food out to families because of the switch to telehealth, centering our distribution efforts on families that were starting or renewing benefits (usually necessitating an office visit) and on highest-risk families that still needed face-to-face visits with our staff.

At this time, we have been operating our modified food pantry since March/April 2020 and have provided healthy food to over 122 families (including 413 individuals and 200 children). The success of this practice is based on the partnerships with food organizations and the dedication and flexibility of our staff. The program helps reduce health inequities by reducing food insecurity among local low income families. From a public health perspective, the program addresses the social determinants of health and improves nuitrition among low income families.

The specific public health problem addressed by this program is food insecurity. The target population is low income families, which make up 11.5% of the population of Ionia County. COVID-19 exacerbated this public health problem by, in some cases, making food more expensive and harder to obtain while simultaneously reducing income for many families.

COVID-19 also affected the plans for this program by making fresh fruits and vegetables (the planned food for distribution) more problematic and by making face-to-face visits with clients more rare. This program was specifically targeted at low income families in our WIC and Maternal-Infant Health (MIHP) programs. In the past, we had attempted to bring in additional sources of healthy food for our WIC and MIHP programs (such as the Veggie Van program) without success. In this case, we decided to create our own food pantry at the Health Department and distribute the food ourselves. Food pantries are obviously not new to public health, but this program is innovative for several reasons.

First, we are operating the program out of the Health Department with Health Department staff. We know of no other Health Department-based food pantries in Michigan.

Second, we leveraged partnerships with a local foundation, a regional food bank, and a local faith-based institution to create the program. We have not created a program like this in our history. We used existing staff and building space to quickly put the program into practice just as COVID-19 was erupting.

We switched from fresh food to shelf-stable food because a COVID-related funding shortage prevented us from buying refrigeration equipment and because our face-to-face client interactions became more rare. We had been forced to switch to telehealth for WIC and MIHP, and so we focused food distribution on three groups: those who visited the Health Department to initiate benefits, those who visited to renew benefits, and those who required in-person visits because of specific risk factors. The economic impact of COVID-19 has created the most adversity in our community, and this practice addressed that challenge by providing free, nuitritious food to low income families. This program is not evidence-based.

The goal of this project was to address food insecurity among low income families before and then during the COVID-crisis. The objectives were to open a food pantry at the Health Department and to distribute healthy food out to our families in need. We first needed to obtain funding to operate the program.

We first reached out to Feeding America West Michigan (FAWM), the regional food bank, and explained our desire to operate a food pantry. FAWM was enthusiastic but identified two obstacles - they could not accept payment from a government entity, and they could not provide the food for free. With assistance from FAWM, we formed a partnership with a local church, Zion United Methodist (ZUMC) in Ionia to sponsor the Health Department. Under this arrangement, the Health Department would order the food, ZUMC would pay FAWM, and the Health Department would reimburse ZUMC. We then reached out to the Ionia Community Foundation and obtained grant funds to purchase the food.

FAWM and ZUMC were therefore intimately involved in the planning process, and continue to be involved in implementation as we purchase food every month. Once all partnerships and agreements were in place, we created a food pantry area in a former supply closet in our building. To address that fact that we were holding fewer face-to-face visits with our low-income families because of COVID-19, we focused distribution efforts on the times that we saw families in person for initial sign-up, benefits renewal, and high-risk appointments.

Fewer face-to-face visits also means that we had to switch from fresh food to shelf-stable food. A COVID-related lack of funding also necessitated this switch. We communicate regularly with the partners involved, and this furthers program goals by keeping the program functioning efficiently.

While we had previously discussed food insecurity with various local partners, the partnership with ZUMC was unexpected and the process could not exist without that partnership. This program helps to address health inequity, but FAWM also benefits from the process. Ionia County is an underserved area for FAWM, and the addition of our pantry helps them to meet their regional and local food distribution goals.

This program was implemented to help maintain the community's health before the pandemic. We recognized the threat to the food security of our low income families and acted with local and regional partners to create a food pantry. A challenge quickly arose in that we were no longer able to see a large number of families face-to-face. This, along with a COVID-related funding shortage, meant that we could not distribute fresh food as planned. We had to tailor the program to distribute shelf-stable food and to make the best use of those times that families visited our building.

We also had to adjust to the fact that MIHP home visits were reduced, and focused our efforts on the highest-risk families. The practice adapted to the pandemic by providing more fruits and vegetables to families in need, and thereby improving food security and nuitrition during a time of crisis for many local families. We adapted our everyday WIC and MIHP procedures to identify families to whom we could easily provide food, and to track the food distributed for reporting purposes (a requirement of the regional food bank).

We therefore fit this program within our existing programs. We hope to continue this program in its entirety post-pandemic, and in fact to expand it to offer food to every client during office and home visits. The key determinant will be funding. We believe that this program has a measurable impact on food security and nutrition among local low income families.