Cracking the Nutritional Puzzle: A Path Out Of Dallas’ Food Desert

Cracking the Nutritional Puzzle: A Path Out Of Dallas’ Food Desert

By Olayide “Olay” Adejumobi, Project Manager, PCCI

Recently, I was shocked to hear that North Texas is one of the hardest hit areas of the country for food insecurity. Shocked, but not surprised. As a registered dietitian and a participant in PCCI’s management of the Dallas Accountable Health Community (DAHC)[1] program, I have seen the Dallas County’s food depravations firsthand, and while this food desert may seem trackless, I believe that by using data, we have ways to create oases.

It turns out that Dallas County has the highest rate of food insecurity among counties in North Texas, with a rate of 15.6%, which is approximately nearly 407,000 residents, per a new report from Feeding America released by the North Texas Food Bank.

I couldn’t agree more with the statement made by Trisha Cunningham, President and CEO of the North Texas Food Bank, “In North Texas, where hunger affects more people than the populations of cities like Seattle or San Francisco, the most alarming statistic is that nearly 40% of those in need are children—a situation that is simply unacceptable.”

As an expert in nutrition, public health, I can tell you that the effects of food insecurity are pernicious and corrosive to families, communities and entire populations. These effects include:

  • Overall poor health and increased likelihood of chronic illnesses such as diabetes, cancer, heart disease, and stroke
  • Mental and social stresses of food insecurity, can lead to social isolation and stigma, while leading to depression due to heightened stress and anxiety
  • Declining academic success: Children who have food insecurities may see an adverse effect on their mental and physical health, reducing their educational opportunities

Ending in 2022, PCCI managed the DAHC[1], a five-year initiative that tested whether identifying and addressing health related social needs of Medicare and Medicaid beneficiaries such as housing instability and quality, food insecurity, utility needs, interpersonal safety, and transportation, would reduce both in health costs and emergency department utilization – we found it did. As a part of the team, I was witness to the myriad of social, economic and health issues the most underserved residents of Dallas faced.

What I can tell you is that food insecurity isn’t just a statistic― it’s a lived reality for many in the southeastern areas of Dallas County.

What I can tell you is that food insecurity isn’t just a statistic― it’s a lived reality for many in the southeastern areas of Dallas County. I’ve seen how non-medical drivers of health can amplify health disparities and lead to adverse health outcomes when quality, nutritious, and affordable food isn’t within reach. The people in these areas grapple with food insecurity due to a complex interplay of non-medical factors. Which makes solving this issue more that just having grocery stores available in those areas, though that would definitely be a good start. The challenges these areas face include:

  • Economic Challenges: The neighborhoods in southeast Dallas have high poverty rates, making it a daily struggle for residents to afford nourishing food. Families often find themselves compelled to prioritize cheaper, less nutritious options due to limited financial resources.
  • Transportation Barriers: Full-service grocery stores, where fresh produce and essential items are readily available, are scarce in these areas, and the lack of reliable transportation compounds the problem, preventing residents from reaching distant grocery stores and compelling them to settle for less healthy options closer to home.
  • Educational Disparities: Low educational attainment in these areas leads to limited knowledge about nutrition and healthy eating, making it a daunting task for residents to make informed food choices.

My journey inside the community data PCCI collected has been an eye-opener. But it’s not just about the numbers we see; it’s about understanding the lives and stories behind those data points. Armed with this information, we have the potential to embark on a path to address food insecurity in these communities through:

  • Community Health Workers: These unsung heroes bridge the gap by providing education, resources, and emotional support to individuals and families in need. They connect people to local resources like food banks and assistance programs and help them develop coping strategies.
  • Community-Led Initiatives: Data-driven strategies can empower grassroots organizations and community leaders to tackle food insecurity head-on. With the PCCI’s data, we can pinpoint, at the block-level, areas of the greatest need and tailor interventions accordingly.
  • Local Government Support: Guided by data-driven insights, local government officials can allocate resources more effectively. Advocacy for policies promoting the establishment of grocery stores and farmers’ markets can be rooted in this specific data.
  • Transportation Solutions: PCCI’s data also identifies transportation deserts within the most underserved areas of Dallas, paving the way for improved public transportation options. This strategic approach can ensure residents can access grocery stores with greater ease.
  • Education and Outreach: Customized nutrition education programs and workshops, based on PCCI’s data, can empower residents to overcome educational disparities and make healthier food choices.

Since the conclusion of the DAHC program, PCCI has developed the Community Vulnerability Compass (CVC), which provides actionable data regarding social barriers to health, access, and well-being of a community’s most vulnerable populations at the block group level. This includes insights into the number of individuals who are eligible for Supplemental Nutrition Assistance Program (SNAP) benefits, which is a leading indicator of food insecurity.

With the CVC, PCCI has been able to learn more about the pressing issues at the block group level in the hardest hit areas of southeast Dallas. PCCI’s data has reinforced the importance of understanding the unique challenges faced by these communities. Through leveraging this data, we can develop new community-led initiatives to engage residents and foster healthier, more resilient communities. The ultimate goal is to ensure equitable access to resources that enable all Dallas residents―regardless of their neighborhood, to lead healthy and fulfilling lives.

About Olayide “Olay” Adejumobi

Olay is a seasoned healthcare professional with ten years of clinical experience and five years of medical nutrition therapy and disease management experience. As a clinical project manager, she collaborated with cross-functional key stakeholders primarily focused on patient outcomes. She earned a Bachelor of Science in Nutritional Science and Public Health plus a Master’s degree in Healthcare Administration and Information Analytics from Texas Tech University.

[1] This project was supported by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $4.5M with 100 percent funded by CMS/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, CMS/HHS or the U.S. Government. Although PCCI’s participation in the AHC Model is now over and CMS is no longer affiliated, we are continuing aspects of the program established during our participation in the Model. 

PCCI’s Community Vulnerability Compass Shows Mental Health Vulnerability Highest In Economically Challenged Areas of Dallas County

PCCI’s Community Vulnerability Compass Shows Mental Health Vulnerability Highest In Economically Challenged Areas of Dallas County

The Parkland Center for Clinical Innovation (PCCI) has released an analysis of Dallas County using its cutting-edge Community Vulnerability Compass (CVC) tool that shows how economically disadvantaged areas of Dallas County are also the most vulnerable to mental health concerns.

Sections in the south and southeast areas of Dallas County, which historically have had socio-economic disadvantaged populations, are revealed to have the highest mental health vulnerability rating (“Very High”) by the CVC. The “Very High” designation indicates that these areas are in the top 20 percent of vulnerability, when compared to the rest of Dallas County.

“In addition to poor mental health, these areas also have some of the lowest life expectancies and highest density of chronically ill populations in the County,” said Steve Miff, PhD, CEO and President of PCCI. “Just like our bodies need preventative care to optimize our physical health, our minds need the same attention to improve our mental health. There is also a strong correlation between your environment and both mental and physical health. In fact, these are tightly interwoven, where poor physical health can negatively impact mental health, and poor mental health can adversely impact physical health. We at PCCI believe that efforts to improve health must address the whole person. To lift the health of our community, you can’t focus solely on chronic diseases, but must also concurrently tackle mental health and address life barriers to access resources, especially in the most at-risk neighborhoods.”

The CVC is designed to help Texas-based organizations seeking to understand (at a county, ZIP code, census tract, or block-group level) not only where its community’s most vulnerable residents live but also many of the underlying, multi-dimensional root cause factors driving these residents’ poor mental and physical health and ability to thrive. The CVC tool includes 26 clinical and socio-economic indicators that reveal the health, resiliency, and economic vibrancy of neighborhoods.

PCCI’s CVC measures mental health by analyzing CDC data on the number of adults 18 years and older who stated that their mental health, which includes stress, depression, and problems with emotions, was not good for 14 or more of the last 30 days. The CVC also analyzes economic, education, safety, environmental, and other diverse health and social indicators to create a full picture of the County’s community health, as well as community health across the entire State.  

“As a start, these data can be extremely useful for community action groups, charities, or healthcare organizations to target education/information about mental health to these high vulnerability block groups. Although this map only highlights those 18 and older, we know caregivers’ mental health affects the children they are caring for, so organizations can also consider supporting schools in these areas. Sharing resources, teaching people about how to recognize when someone around them is struggling and promoting activities that encourage improving mental health are things that each of us can do,” said Jacqueline Naeem, MD, Senior Medical Director at PCCI.

Dr. Naeem added that the CVC’s analysis includes a wide range of data points, providing a true, holistic picture of who needs the most help and where to find them. The data PCCI provides is based on the best, most currently available information, which serves as a powerful tool to allow for proactive support of those in need.

“There is still stigma that exists around mental health, and mental illness that we need to work together to overcome,” said Dr. Naeem. “This data allows us to focus on the whole person by concurrently addressing the physical and mental needs of our neighbors and identifying their local barriers to access services. In doing so, the location and type of services can be tailored in ways that are more convenient for the recipients and education can be hyper-localized and tailored to those recipients in a more culturally empowered way.”

For more information about PCCI’s Community Vulnerability Compass, go to: https://pcciprod.wpengine.com/pccis-community-vulnerability-compass/

About Parkland Center for Clinical Innovation

Parkland Center for Clinical Innovation (PCCI), founded in 2012, is celebrating a decade as a not-for-profit, healthcare innovation organization affiliated with Parkland Health. PCCI leverages clinical expertise, data science and social determinants of health to address the needs of vulnerable populations. 

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PCCI CEO Statement – Dallas County Reaches Herd Immunity, More Work To Be Done

Statement from PCCI CEO Steve Miff:

“On July 4, Dallas County reached the 80 percent herd immunity threshold. This threshold is made up

by 46.6 percent of the total population being vaccinated and 48.7 percent of the population with natural immunity having recovered from being infected by COVID-19.

While this represents good progress, it is important that we understand the work is not over. We must continue to push for vaccinations so COVID and its variants can’t again take hold and diminish the progress we’ve made. Reaching the 80 percent herd immunity rate is not like flipping a switch, but a continuum in our journey.  It is an important accomplishment which is a credit to the residents and public health leaders who have committed themselves to crush COVID. While the whole community in average reached the 80 percent mark, there are only 49 ZIP codes above the 80 percent threshold with 45 ZIP codes still below the 80 percent mark. There are still significant pockets in the community that remain vulnerable.

How we got here

The calculations used to measure heard immunity track individual level data for both vaccinations administered and COVID test results since the beginning of the pandemic.  For those infected, yet not tested there are a 4x Adjusted Incidence Rate Ratio [AIRR] for the adult population and 5x for the pediatric group based on national and local seroprevalence data. The model also calculates an overlap 28 percent of vaccinated population of Dallas estimated to have had prior COVID-19 infection and recovered.

Delta Variant

Further, the current Delta variant is predicted to make up about 25 percent of COVID-19 cases locally, doubling approximately every two weeks. In one month, that could put the Delta variant in the range that has caused a new wave in infections in the UK, though their estimated immunity was below the herd immunity threshold for Delta.

The significantly higher viral loads and more infectious nature of the Delta variant could put the herd immunity target as high as 88 percent to suppress infection spikes when the Delta variant becomes the dominant variant in a few weeks’ time.

Vaccinations Lag

As a county, we’re still behind on vaccinations: Only 38 percent of the total population with completed vaccination series and 47 percent of the total population with at least one dose (61 percent of adults and 80 percent of those over the age of 65 years).  While previous infections and partial vaccinations do provide a level of protection, all evidence suggests that full vaccinations are the most effective way to stay safe against the delta variant.

Why is getting vaccinated still very important:

  • Infections remain very low for those vaccinated – local data from Parkland and the Dallas County Health & Human Services Department suggests an infection rate of only 0.04 percent for those vaccinated. Getting vaccinated doesn’t only protect you, but those around you, including the children who are not yet eligible for a vaccine.
  • Long COVID (prolonged COVID related symptoms such as fatigue, brain fog, muscle pain, shortness of breath, and loss of taste and smell) is prevalent in 10-30 percent of those infected and mortality for those unvaccinated is still a concern. Not getting vaccinated is rolling the dice on dying or dealing with long-term medical issues. 

The message is simple: don’t wait to get vaccinated. For those still hesitant, the safety and efficacy studies to date are overwhelmingly positive.  There are also two key upcoming milestones that should give further confidence to those who remain hesitant: Full FDA approvals for the mRNA vaccines expected in the upcoming weeks and approval for the under 12-year-old groups in the fall.”

-Steve Miff, PhD, President & CEO of Parkland Center for Clinical Innovation (PCCI) 

To monitor herd immunity and vaccination progress in Dallas County go to PCCI’s COVID-19 Vaccination and Herd Immunity Dashboard hosted on the Dallas County Health and Human Services’ website: https://www.dallascounty.org/covid-19/.

Background on PCCI’s herd immunity measurements

PCCI’s forecast for herd immunity is based on an innovative yet vetted statistical and immunological model and analysis of spread and management of diseases within communities. Further, PCCI’s 80 percent range for reaching herd immunity is in line with national estimates, such as that of Anthony S. Fauci, MD, Director of the National Institute of Allergy and Infectious Diseases, who recently gave a range of 70 to 90 percent and the World Health Organization which gave a 60 to 70 percent range of infections and vaccines to reach herd immunity*.

PCCI’s forecast and estimates have been developed in coordination with community health leaders in Dallas County, including the DCHHS and Parkland Health & Hospital System.  Recently, PCCI has been collaborating with the leadership and expert teams at the Institute for Health Improvement on modeling.

*New York Times, Dec. 24, 2020: “How Much Herd Immunity Is Enough?”

https://www.nytimes.com/2020/12/24/health/herd-immunity-covid-coronavirus.html

 

PCCI COVID-19 Update: Vaccinations Help Dallas County’s COVID-19 Risk Drop 40 Percent in May

DALLAS – Due to vaccination levels and reduction in new COVID-19 cases in Dallas County, the Parkland Center for Clinical Innovation’s COVID-19 Vulnerability Index has recorded a 40 percent drop in average vulnerability from April to the end of May.

The Vulnerability Index decrease can be attributed to a moderate increase in vaccines, a 10 percent increase in vaccinated people (partial or complete) month over month, and a 37 percent decrease in active cases.

The ZIP code with the highest Vulnerability Index, 75243, has a 12.20 vulnerability rating, however that was a decreased by 61 percent from April. This decrease was driven by vaccinations.

Most vulnerable zip codes. The cases have continued to reduce substantially month-over-month. (See list below)

“Thanks to the vaccination programs implemented throughout Dallas County, we continue to see progress in our fight against COVID-19,” said Thomas Roderick, PhD, Executive in Residence at PCCI. “Our latest Vulnerability Index report is the most positive yet, with new cases slowing and modest, but important participation in the vaccination program continuing. This progress is a credit to the outstanding efforts of our public health leaders and residents devoted to crushing COVID.”

One of the hardest hit ZIP Codes during the past year, 75211, which includes the areas around Cockrell Hill and Oak Cliff, continues to be in the top 10 most vulnerable ZIP codes, however, its May rating of 9.63, is a massive improvement over its high of 196.9 in January.

Launched in June of 2020, PCCI’s Vulnerability Index identifies communities at risk by examining comorbidity rates, including chronic illnesses such as hypertension, cancer, diabetes and heart disease; areas with a high density of populations over the age of 65; and increased social deprivation such as lack of access to food, medicine, employment and transportation. These factors are combined with dynamic mobility rates and confirmed COVID-19 cases where a vulnerability index value is scaled relative to July 2020’s COVID-19 peak value. The PCCI COVID-19 Vulnerability Index can be found on its COVID-19 Hub for Dallas County at: https://covid-analytics-pccinnovation.hub.arcgis.com/.

Recently, PCCI revised its COVID-19 herd immunity forecast, 80 percent of residents either having recovered from COVID-19 or having received a vaccination, from mid-June to July, due to a slowing rate of immunizations. However, as of the end of May, Dallas County is closing in on the 80 percent goal, at 75.5 percent herd immunity.

“Without question, vaccinations are the key to Dallas County reaching herd immunity,” said George “Holt” Oliver, MD, Vice President of Clinical Informatics at PCCI. “Vaccinations have been the primary reason we’ve seen a reduction in risk and why we are in sight of reaching the herd immunity threshold. The vaccinations for adults and children over 12 years old, are effective, easily obtained and quickly administered. We should all do our part to get vaccinated and encourage others to do the same. That is the way we will crush COVID.”

Data Sources:
To build Vulnerability Index, PCCI relied on data from Parkland Health & Hospital System, Dallas County Health and Human Services Department, the Dallas-Fort Worth Hospital Council, U.S. Census, and SafeGraph.

About Parkland Center for Clinical Innovation
Parkland Center for Clinical Innovation (PCCI) is an independent, not-for-profit, healthcare intelligence organization affiliated with Parkland Health & Hospital System. PCCI leverages clinical expertise, data science and social determinants of health to address the needs of vulnerable populations. We believe that data, done right, has the power to galvanize communities, inform leaders, and empower people.

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PCCI’s New MyPCI App Informs Individuals of COVID-19 Exposure Risk

Rating tool for measuring COVID-19 risk adopted by the Diocese of Dallas Catholic Schools

Dallas, Texas – Parkland Center for Clinical Innovation (PCCI), which improves healthcare for vulnerable populations using advanced data science and clinical experts, has released the MyPCI App, a solution, exclusive to Dallas County, that will help individuals make informed choices by providing an on-demand, location-based personal risk assessment of possible COVID-19 exposure.

The MyPCI App, free to register and use, is a secure, cloud-based tool that doesn’t require personal health information and doesn’t track an individual’s mobile phone data. Instead, it is a sophisticated machine learning algorithm, geomapping and hot-spotting technology that uses daily updated data from the Dallas County Health and Human Services (DCHHS) on confirmed positive COVID-19 cases and the population density in a given neighborhood. Based on density and distances to those nearby who are infected, the MyPCI App generates a dynamic personal risk score.

To use the MyPCI App, go to, https://pcci1.wpengine.com/mypci/, click on the link and register (Using code: GP-7xI6QT). Registration includes a request for individual location information that will be used only for generating a risk assessment, never shared. Once registered, simply login daily and a COVID-19 personal risk level score will be provided along with information to help individuals make informed decisions about how to manage their risk.

“Proximity continues to remain one of the most important factors in pandemic management and personal protection,” said Steve Miff, PhD, PCCI’s President and CEO. “While we wait to receive a vaccine, we can control our own risk of exposure and help bend the curve.  The MyPCI App is a simple to use tool that will give you an understanding of the COVID-19 risks in your vicinity and reinforce the need for social distancing, face covering and hand washing.”

(continue below video)

The MyPCI App is based on highly effective technology that has already been proven in the field. The app is built on the PCCI COVID-19 Proximity Index designed for the Parkland Health & Hospital System. The Proximity Index looked at the proximal risk score of patients who were scheduled for in-person medical appointments. If a person was identified at high or very high risk, the appointment was proactively shifted from an in-person visit to a telephonic or virtual visit – protecting both patients and health care providers. Also, timely screening and care plan was offered proactively. Data analyses from over 500,000 Parkland patients indicates that an individual with a high or very high proximity index had a seven times higher risk of ending up being infected. The success of this Parkland program has prompted additional development of the tool that is now available to the public as the MyPCI App.

“I am pleased that PCCI is making this service available to the public, as it uses the same tool which has helped us at Parkland better care for the Dallas County community by providing important information that indicates one’s risk for developing COVID,” said Brett Moran, MD, Chief Medical Informatics Officer for Parkland. “Parkland and PCCI have been using these algorithms from early in the pandemic to effectively provide outreach to high-risk individuals which helps them as well as their family, friends and the community at large.”

To ensure all residents of Dallas County can use this tool to empower themselves with better information, the MyPCI App is also available at Parkland at https://www.parklandhospital.com/information-about-coronavirus-disease-2019-covid19, using PARK-xaoHtR registration code. It is also available at the Dallas County Health and Human Services Department at http://www.dallascounty.org/covid-19/ using DCHHS-62ta7b registration code.

“We have been pleased throughout this pandemic to be partnering with PCCI so that we can use their cutting-edge technology and data applications to address COVID-19,” said Dr. Philip Huang, MD, MPH, Director of Health and Human Services for Dallas County. “This latest tool is another example of how Dallas County benefits from the tremendous resources and partnerships we have here.”

An early, enterprise-wide adopter of the MyPCI App is the Diocese of Dallas Catholic Schools, to help better inform its student’s parents. The Diocese of Dallas Catholic Schools represents more than 61,000 students in 38 different schools, many of which are in Dallas County. Parents using the MyPCI App will receive information allowing them to work collaboratively with teachers and administrators in an informed way.

“We are always looking to innovate and partnering with PCCI on this initiative is a great opportunity to empower our parents and families with information that makes then engaged partners with our team in containing the virus and keeping our staff and students safe,” said Matt Vereecke, Superintendent of Schools, Catholic Diocese of Dallas.

A goal for PCCI in rolling out the MyPCI App, is to give tools and information to help Dallas County residents to make the most informed decisions possible as the COVID-19 pandemic continues to spread and while the vaccination program becomes more widespread.

“The key for all residents of Dallas County to help mitigate the spread of COVID-19 is to register and use the MyPCI App as quickly as possible,” said Dr. Miff. “While we are very encouraged by the vaccination initiatives, they will take time take, which means now is not the time to let our guard down. The pandemic is still raging, so we need to use personal information and awareness about our own individual and household risks to re-enforce and manage the things that we can control while we wait for broad implementation of vaccines.”

 About Parkland Center for Clinical Innovation

Parkland Center for Clinical Innovation (PCCI) is an independent, not-for-profit, healthcare intelligence organization affiliated with Parkland Health & Hospital System. PCCI leverages clinical expertise, data science and social determinants of health to address the needs of vulnerable populations.

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Get Your COVID19 Person Risk Score Now

To register and login to the MyPCI App to quickly understand your personal risk of COVID-19 exposure in Dallas County, please click on the image below below or go to: https://mypci.pccinnovation.org/my-proximity to register, Using code: GP-7xI6QT. The first assessment takes 24 hours.