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00:00:01:00 - 00:00:25:20
Tom Haederle
Welcome to Advancing Health. Food insecurity doesn't always mean not having enough to eat. It can also describe lack of access to healthy food. Coming up on this podcast, we learn more about Cleveland Clinic's broad strategy to provide opportunities for healthy eating to all of the communities it serves. As today's guest says, "we look at food as medicine."

00:00:25:23 - 00:00:52:14
Nancy Myers
Hi, I'm Nancy Myers from the ºÚÁÏÕýÄÜÁ¿ Association. Thank you for joining us today as we have a great conversation planned with Vickie Johnson, who's the executive vice president and chief community officer for the Cleveland Clinic, based out of Cleveland, Ohio but with operations worldwide. Today, we'll be talking a little bit about how they're understanding and meeting the needs of both their patients and their communities as they seek to drive better health for all.

00:00:52:15 - 00:00:56:23
Nancy Myers
So, Vickie, thanks so much for joining us today. Appreciate you being here.

00:00:56:25 - 00:01:01:03
Vickie Johnson
You are welcome. And thank you for the invitation. It's an honor to be here.

00:01:01:09 - 00:01:07:06
Nancy Myers
Tell me a little bit about the work that you and your team lead at the Cleveland Clinic, just to ground us.

00:01:07:08 - 00:01:33:21
Vickie Johnson
Sure. So in 2023, Cleveland Clinic established the community health office. And I'm blessed to be the leader. As you said in the introduction, we are an enterprise with a global footprint. So it's my job to lead an awesome team at developing a strategy to care for every community in which we're located. And our objective is to build healthy communities together.

00:01:33:24 - 00:02:01:04
Vickie Johnson
We have a strategy that we'll talk about a little later to make sure that we use the same approach to engage with every community, so that the outcomes and the strategies that we have are locally relevant. So we're happy to do this work. We are a service line to every institute and department at Cleveland Clinic so when we discover the needs of our local communities, we work as a partner, a non-physician partner

00:02:01:04 - 00:02:12:09
Vickie Johnson
so we have a dyad partnership to work together to leave the walls of the hospital and go into the community where patients and community members are to address those needs together.

00:02:12:14 - 00:02:33:01
Nancy Myers
So I know that one area that you've been focusing on through the work of your team and over the last few years has been what some people would refer to as food insecurity. But your lens is a lot broader than that, or broader than just simply access to food. Can you tell us about the work to address nutrition that the Cleveland Clinic has undertaken?

00:02:33:03 - 00:03:02:24
Vickie Johnson
Yes, I'm happy to do that. So you're correct. So we look at food as medicine and we look at food as something that we can engage communities around. It's easy to understand that at the foundational level, everyone needs access to food, but it needs to be good food. So in the urban communities in which we're located sometimes it's not access to food, it's access to good food.

00:03:02:27 - 00:03:41:24
Vickie Johnson
We have patients and neighbors who shop at gas stations and convenience stores, and so they have something to eat, but it's not necessarily nutritious. So we've worked in partnership with the communities in which we're located, with local health departments, with the business community, our stakeholders, to figure out how we can leverage the economic impact that we have in each community to address nutrition, which then includes how do we leverage who we are to attract retailers who will provide nutritious food so access to better food options.

00:03:41:27 - 00:04:06:04
Vickie Johnson
And then also how do we educate and work in collaboration with our community to understand how nutrition is a really big part of health. And children in particular, how they perform at school, and everything really is based on that foundational need that we all have. But we do not all have access to the same quality of food.

00:04:06:07 - 00:04:27:01
Nancy Myers
So it sounds like you're really taking a multi-pronged approach in terms of the strategies as you go from community to community that you serve. And I heard you mention retail partnerships and education. Can you maybe talk a little bit more about what some of your foundational strategies are in different communities that you're most proud of?

00:04:27:03 - 00:04:54:22
Vickie Johnson
Absolutely. So let me start even broader, first, to say that when we think about food, we looked at food from an enterprise perspective and as a health care provider. So food at the bedside. Food that we sell on our campuses. So the types of retailers and restaurants that we allow to have a presence on our campus that we sell to patients' families and caregivers.

00:04:54:29 - 00:05:22:15
Vickie Johnson
And then food in the community, which is the space that I lead. So we've leveraged relationships that we have with food vendors, those that we do business with at the bedside and on campus to see how can we partner together. The whole thing, the whole approach that we use is how do we leave the hospital? We want to go where people are so that we have the greater opportunity to have an impact on the health outcomes.

00:05:22:15 - 00:05:46:00
Vickie Johnson
So how do we leverage partnerships? So we have great partnerships with Morrison Health, for example. The relationship started inside the hospital, but we both care for the same community. So how do we go together to provide education. So how do we leverage the chef that is preparing great meals for our patients in the community as well? And how do we bring that to communities where people are?

00:05:46:00 - 00:06:21:18
Vickie Johnson
So how do we use cooking demonstrations and education and recipes in libraries and community centers, combined with other partners like the American Heart Association. So we leverage those relationships we have. Also, we've been so fortunate on our main campus area, which is in the city of Cleveland in the Fairfax neighborhood where we've been over 100 years, and we've been in a community where the people who are our neighbors had not had a quality grocery store for over 30 years.

00:06:21:20 - 00:06:52:13
Vickie Johnson
And in 2018, they told us the best thing that we could do for them as a partner, as an anchor institution, is to leverage our employee base and the amount of dollars that we spend to attract a retailer to a community, quite frankly, that they could not do this on their own. So the population was declining, the number of households, the educational attainment, all the things that retailers look for to make a good business decision.

00:06:52:15 - 00:07:18:12
Vickie Johnson
This community did not have it. But what they did have is a committed partner in Cleveland Clinic. So we leverage the number of caregivers on main campus, the number of patients that visit every day, the number of construction workers that parked cars. We use all of this data to have conversations, and were successful in attracting a high quality retailer.

00:07:18:15 - 00:07:45:08
Vickie Johnson
And now we're working together. It's Meyer, and they're using the urban format to work with us in the community. So 40,000ft² of fresh groceries that did not exist before for our community. And so we're really pleased and so happy about that because when we went back to the community in 2023 to have the same kind of conversation, to ask on a regular basis, how do you define health?

00:07:45:10 - 00:08:12:13
Vickie Johnson
How can we be a good partner? And we collect data. And once that was looked at, we found no one described a food desert anymore. No one said, can you help us with access to food anymore? And we also had an economic impact with the 50 jobs that were created as well as a result of that. So that's what we've been doing, is talking with the community on a regular basis.

00:08:12:13 - 00:08:39:17
Vickie Johnson
How can we be helpful and really be really transparent about what we can and what we cannot do, and then work together to make that happen? So in other communities, we do not have 20,000 caregivers. You know, we do not have that type of impact. But how can we leverage, again, our vendors to make those opportunities and to increase the healthiness of every community that we serve?

00:08:39:19 - 00:09:03:25
Nancy Myers
And I love how you talked about bringing your workforce in, your caregivers, because they are one of our first communities, right? And so being able to put in this market, as you have in Cleveland, serves the people who live in the neighborhood. And it also is a nice benefit and service to your team members, who I assume use it every day or on a regular basis as well.

00:09:03:27 - 00:09:24:25
Vickie Johnson
That is so true, and I would be remiss if I didn't say where we do not have those same opportunities because we don't have the same level of economic impact, we're working with local communities around food pantries and nourish pantries, where it's not just food, it's also the education and talking with a health care provider  - and almost issuing

00:09:24:25 - 00:09:49:28
Vickie Johnson
and we have - food prescriptions to make sure that we're making the connection. And again, food is health. And we have wonderful initiatives where we focus primarily on populations that need us the most, It's a place-based strategies. We've decided to focus on pregnant women and children around food and nutrition, infant and maternal health. All women in the community.

00:09:49:28 - 00:10:02:04
Vickie Johnson
So we've been able to really connect everything together: food insecurity, access to care, exercise, all of that to get to the outcomes that we hope to see in years to come.

00:10:02:06 - 00:10:17:24
Nancy Myers
Let's talk about what the outcomes are that you're measuring now, as well as those that you're looking to measure over time to see how you're making an impact through these programs and other community programs that you have in place.

00:10:17:26 - 00:10:40:15
Vickie Johnson
Well, time is the first thing we want to focus on. It will take time. And I think in health care, we're sometimes, you know, looking for instant results because that's what you see with health care in terms of surgery or medicine. And so in this case, we all know this will take time. So we look for indicators that evidence has shown us will have a difference.

00:10:40:15 - 00:11:20:06
Vickie Johnson
So for example we are looking for pre-and-post test. And so at the end of a 12 week or 16 week or 90 day initiative, whatever the time frame is, have we been able to increase one's awareness and knowledge and a change in behavior? For example, we have an initiative called Healthy Moms and Healthy Babies where we've eliminated barriers like transportation. Where a pregnant mom, she's pregnant and she has children, and so she's able to shop with $200 a month and shop for healthy food using her cell phone,

00:11:20:09 - 00:11:49:29
Vickie Johnson
using the computer. And having food either picked up or delivered at the door side. So through that experience, we're able to stay with that mom throughout the first year of the baby's birth. And then we can measure. And it's self-reported. And because we have community health workers that are really closely building relationships with these mothers, we know the change in behavior.

00:11:49:29 - 00:12:21:15
Vickie Johnson
We can believe it because we see it. We're closely aligned with them. So when we change our behavior and when we recognize, okay, we know better. I accept that and I'm actually going to change how I eat and what I purchase, how I prepare it. Then we can expect, based on evidence, that we will see an increase for example, in the birth weight of the newborn, we can see a change in the need for certain medications because we're eating better.

00:12:21:16 - 00:12:41:23
Vickie Johnson
So we're hoping and we expect to see a healthier community at the end of this work. And when it's not perfect, we do it again. You know, we continually form and keep these relationships with folks. And when you don't exercise as much as you used to, we'll start all over again because we're going to be in the community

00:12:41:23 - 00:13:15:04
Vickie Johnson
forever and we're there as a partner to institute these behaviors that we know will produce the outcome that we're looking for. The access to food piece, again, when we've removed the necessity of a person to buy their dinner at the gas station because they now can purchase it at a market, we know people will become healthier and the outcome and their future is brighter, because we've been a part of bringing that to the community.

00:13:15:07 - 00:13:44:15
Nancy Myers
Thanks so much. And one last question, kind of as a wrap up. We'll play Monday Morning quarterback. You've had several years of experience in this world. And you've had some successes and likely you've had some things that didn't go as planned. What are key pieces of advice, maybe 1 or 2 things that you would give to another organization that was either just starting out addressing some of these same things, or was interested in expanding the work that maybe they've already started.

00:13:44:18 - 00:14:22:06
Vickie Johnson
I think we have to give ourselves grace at the very beginning and celebrate every success. Sometimes we get caught up in huge numbers, but every success is huge to that individual, is huge for every child that we are a partner with to really care for people for life. And if we start well, then we can end well. You know, celebrate ten people completing an initiative, celebrate 30 and then those ten or 20 or 30 are going to share that experience with their neighbors.

00:14:22:06 - 00:14:55:23
Vickie Johnson
And then you'll get to the place where you're seeing 3 or 4 or 500 as we are today. We have a fitness center also on main campus with world class equipment, and now we're up to thousands of people that come in every day. Unique individuals that are using our fitness facilities with physicians on staff. You know, present, with dieticians present in the same building where you can have yoga and you can soon teach each other, teach your neighbors how to eat better.

00:14:55:23 - 00:15:21:09
Vickie Johnson
So be in this for the long term is what I would say. And community is also hard to measure impact. Again health care is different. We have 400 surgeries, you know, scheduled for today and we know the outcome within minutes. This is very different, but it has a greater impact in one's sustaining their health in the community in which they're living.

00:15:21:09 - 00:15:34:17
Vickie Johnson
So partner with the physicians and know that we are just as important and in some cases more important in partnering with patients when they go home and community members to live a healthy life.

00:15:34:19 - 00:15:52:23
Nancy Myers
Well, on behalf of AHA, I'd like to say thank you, Vicki, to you and your team and the Cleveland Clinic for the work that you are doing to make a difference one person at a time, one community at a time. It sounds like you've had amazing success and have many more successes to come.

00:15:52:25 - 00:15:54:26
Vickie Johnson
Thank you.

00:15:54:28 - 00:16:03:08
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.