In 2020, association member RWJBarnabas Health, in New Jersey, declared itself an antiracist organization and was faced with the challenge of living out that declaration.

“We knew that part of the challenge is working on educating our workforce,” says DeAnna Minus-Vincent, MPA, executive vice president and chief social justice and accountability officer at RWJBarnabas Health. “We needed to really raise people’s awareness of systemic racism. We needed to get people comfortable in talking about issues around race.”

Annual equity challenges were one accessible way to get people talking. After a successful health equity challenge in 2020, the health system focused its 2021 challenge on food equity. Through a system called ProHabits, participants received activity prompts for 21 days via text or email with an article, video, or animation about food insecurity and its links to structural racism. Participants were encouraged to write a brief reflection on a company portal and earned points for each activity and reflection completed. Weekly prizes and a final lunch for the most engaged hospital in the health system helped keep participants engaged.

Daily messages to program participants included videos about food insecurity.

“We liked the platform … It was easy, it was phone-based, which was important for our workforce. We have everything from neurosurgeons to front-line staff. It ranges in education, it ranges in their technological abilities, and also [in] their access to desktop computers and the time that they have to spend,” Minus-Vincent says. “We wanted to make it available and accessible for all, and, for two to five minutes a day, we thought that was a really good way for people to learn.”

For the final five days of the challenge, participants were tasked with spending only $6.25 a day on food to simulate the reality of relying on Supplemental Nutrition Assistance Program (SNAP) benefits.

“We have seen that food insecurity leads to the inability to get food [patients] need, to take the medications that they need, because they’re making a choice between this or that. It leads to depression, it leads to an inability to be productive in our communities — so students in schools and adults in the workplace,” Minus-Vincent says. “We know that it also, especially for seniors, leads to more hospitalizations, more time in nursing homes.”

The Food Equity Challenge helped show health care providers their potential impact. RWJBarnabas Health is in the process of introducing a universal social determinants of health (SDOH) screening tool. By making screening universal, the health system hopes to reduce stigma and bias and refer more patients to resources.

The health system has two food hubs in New Brunswick and Newark, along with a food pharmacy in Jersey City that allows patients to shop for groceries and apply for SNAP. The health system often helps patients apply for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Minus-Vincent appreciates the flexibility these programs have offered to address food insecurity during the pandemic, including by providing virtual nutritional education and expanding the variety of covered food items to allow for cultural nuances.

“It is curable, it’s something we can fix — both by streamlining how people get government services and supports, and we are working toward that end with our government partners — but also ensuring that they get food today through our food banks,” Minus-Vincent says. “We are highlighting this through our providers and showing them it is somewhere we can make a difference.”

The Food Equity Challenge is part of the health system’s larger “Ending Racism, Together” initiative, a four-pronged strategy that includes:

  • ensuring antiracist care to all patients, for example, by promoting patient-clinician concordance and reducing technological disparities;
  • creating a workforce that reflects the communities the health system serves and enforces disciplinary actions equitably;
  • reaching into the community, including SDOH screening, providing interpretation and translation services, and providing tailored, streamlined follow-up; and
  • integrating equity into health system operations, including communications, food services, and procurement.

“As we move forward, we have to look at history,” Minus-Vincent says. “We cannot change where we are going until we know where we have been and understand the policies put in place. Are they still applicable for the changing demographic?”

Videos encouraged participants to consider the implications of policies like redlining on health.

Minus-Vincent hopes to continue launching challenges and simulations in the future and expand even more beyond hospital walls. Another company already has agreed to challenge RWJBarnabas Health in next year’s simulation, and the health system hopes to include local elected officials in the challenge, too.

“We do not believe that training for this particular subject is one-and-done,” Minus-Vincent says. “It’s constant conversations, it’s constant learning. How do you flex that muscle to continue to engage with one another?”