Marydale DeBor loves her job. The pixie-sized woman, with a short crop of gray hair and funky glasses, runs Fresh Advantage, a consulting firm that helps hospitals and medical schools integrate improved food and nutrition programming into their approaches to healthcare.
After working for many years as a lawyer, DeBor started down her current path while working for New Milford Hospital in Connecticut, where she was a vice president in the Department of External Affairs. In 2010, when the Affordable Care Act (ACA) took effect, it included stricter regulations on the healthcare sector. In order to keep their tax-exempt status, all nonprofit hospitals had to show clear connections between their work and the impact they had on their community’s health. DeBor, with experience working with both the Avon Foundation and Fannie Mae Foundation, was put in charge of developing New Milford’s community component.
Poking around in the behind-the-scenes operations of the hospital, DeBor was alarmed to find food included under ancillary services, along with trash, laundry, and housekeeping. “Why?” DeBor asked her then CEO, Dr. Joseph Frolkis. Frolkis admitted he wouldn’t eat a thing that came from his work cafeteria.
As DeBor saw it, changing the hospital’s approach to food was one of the best ways to improve the patient experience and begin disease prevention work in the community. She didn’t have to work hard to convince Frolkis to support her changes.
DeBor launched a three-year plan to overhaul the backbone of the organization’s food, health, and nutrition systems. Her first step was to get bids for a new culinary vendor. Then they ditched the deep-fat fryers, retrained kitchen staff, and hired a classically trained chef. The team revamped and shrunk the menu choices, making the selections simpler so that they could focus on wholesome, fresh ingredients sourced locally as often as possible. When they completed this phase, their patient satisfaction levels rose from 30 to 99 percent.
Next under her laser focus was elder malnutrition. They looked at the older patients who were relapsing after hospitalization and found that it was often people who were hungry and dehydrated. Even more surprising was that many people over 65 were already malnourished at admission. This fact proved to DeBor that the hospital’s outreach needed to start before community members arrived at New Milford.
DeBor spearheaded a senior supper program for offsite visitors. They charged $5 for a beautiful, healthy meal. “We were using labor we were already paying for, expanding our reach into the community, and we had to underwrite just a tiny amount,” says DeBor. The community investment benefit, what they needed to fulfill to remain tax-exempt under the ACA, was immediate.
Alongside Anne Gallagher, a chef trained at the Natural Gourmet Institute in Manhattan who often partnered with DeBor, the team also started a Youth Chef Advocate program for public school kids. The nine-month program took kids out to farms, out on boats, and then back into the kitchen to learn how to prepare their harvest. To make it even more like the real world, the kids had their own knife kits and wore chef’s whites. And their cell phones? They were put away in their backpacks.
A Hub-and-Spokes Model
DeBor likes to describe the work she does as a “hub-and-spokes model.” The healthy food “hub” is the hospital food service operations, which support the “spokes,” a range of activities that address patient nutrition education, employee wellness, and food insecurity within the community.
With New Milford Hospital humming along, DeBor continued her impassioned health advocacy. In 2011, the leaders of Connecticut Mental Health Center (CMHC) in New Haven, Connecticut found DeBor. At the time, CMHC didn’t even have its own kitchen. Meals came from a tunnel underground that connected them to the Yale-New Haven Hospital across the street.
According to the National Alliance of Mental Illness, psychiatric patients die 25 years earlier than the general population, and two thirds of those are from non-psychiatric causes. Because of these dire numbers, the mental health facility required a change in tactics for DeBor, but food was still at the center of the hub. She started with what she called the Food Transformation Project. She tapped chef Gallagher again, along with a nutritionist, and a social anthropologist who specializes in financial counseling for mentally ill, to round out the team.
Like at New Milford, DeBor linked several spokes to her hub. There was a café of course, and simple foods available for takeaway. Newly offered nutrition counseling was connected to the patient’s primary care doctor and they also created the Better Eaters Club, which was a six-week learning module that helped patients answer some of these questions: How do you shop? How do you make a budget when you live on Supplemental Nutrition Assistance Program (SNAP)? And how do you prepare nutritious food?
In partnership with New Haven Farms, the team planted an edible garden in the courtyard. “Our inpatients––involuntary committed people––come down to garden and harvest. And they take flowers back up to their rooms,” says DeBor.
Because DeBor had so much interaction with the hospital across the street while she was working at CMHC, she also began speaking at the Yale School of Medicine. The role became more formalized after an enterprising pair of first-year medical students, approached her, shared the grief they felt over the gaps in their medical training, and proposed a 12-session elective program to be added to their fall semester. DeBor offered advice on who to reach out to in the community, and what areas of food policy to include in their curriculum.
This fall, the Yale medical students’ will have the option of taking U.S. Health and Justice for the third year in a row. The class is growing in attendance each semester and gaining more traction within the medical school. But it’s still an elective.
“We want the class to be more than extracurricular. We feel everyone should know this,” says Robert Rock, one of the students who created the class. DeBor is still very close to her community of impassioned students, even taking them out to dinners. “Food justice is a social movement, but you have to do it on the ground, not in the classroom. Sometimes I feel silly that I’m so moved, but I don’t think you can do this without being moved,” she says.
Fixing hospitals sounds hard, right? But somehow DeBor finds the solutions. “The key is getting community involvement,” she says. “Partner up. Find the resources. You don’t have to do it yourself.”
Since DeBor left New Milford Hospital, it has gone through a merger and only a few elements of her program remain. But her work at CMHC is still very much in evidence, as is her work at Yale, where she is influencing the doctors of the future. “Success isn’t when I go away and it falls apart,” says DeBor. “It’s when I go away and it lasts.”