Interview With Marla Guarino and Beth Machnica of BNMC

Innovative, Collaborative, and Passionate: Two WNY Leaders Bearing Healthy Fruit

An interview with Buffalo Niagara Medical Campus (BNMC) Health and Well-being Department leaders Marla Guarino, BNMC Farm to Hospital Catalyst, and Elizabeth “Beth” Machnica, BNMC Director of Community Well Being.

BNMC leaders Marla Guarino and Beth Machnica

BNMC Health and Well-being Department leaders Marla Guarino and Beth Machnica

Quick, think of those individuals you know that are extremely passionate about improving the lives of fellow Western New Yorkers, creating innovative programs and carrying out tremendously effective activities that touch the lives of so many, noticeably changing our community for the better. Then multiply by 10. Or, maybe by 100! That’s Marla and Beth, two incredibly dedicated dietitians that have worked for years to provide WNY communities ever more access to healthy, affordable food, while also greatly improving the health effects along the distribution chain, from local farmers to large hospitals to consumers, especially for those in need. Sitting down with these talented, driven individuals, it is easy to see why so many groups they bring together become so energized when working with them to bring about healthier outcomes for us all. Their infectious energy rubs off.

Working out of the Buffalo Niagara Medical Campus’ headquarters next to all the region’s top healthcare companies, with offices above BNMC’s Innovation Center facility where they have direct access to the most innovative thinkers around, Marla and Beth have clearly become skilled at creating bridges that synergistically multiply the positive work everyone is doing individually towards making us all healthier. Their department, “Health and Well-being is currently working on critically improving food and wellbeing for the community through a number of unique small and large programs that involve the input from, and close collaboration among, various actors throughout Buffalo, from the heads of industry down to small local farmers. Beth explains how it all works saying, “We have state of the art facilities at the Medical Campus, like Gates Vascular Institute for example. If you have a heart attack or stroke, or are very sick, you come to the Campus to Gates. But we know that only 20% of someone’s health outcome is determined by the direct healthcare they receive. The rest of it, the 80%, is your environment, the zip code in which you live, your behavior, your choices, and all that’s inter-related. BNMC’s Strategic Health Initiatives department is committed to targeting that 80%, affecting health outcomes through the environment, access to healthy food, active living, clean water, fresh air, greenspace, mental wellbeing and so on. All of our initiatives are directed at that, but working in tandem with the healthcare systems, because you can’t have these without the other.”

Marla makes it clear that they aim to make the Buffalo Niagara Medical Campus a place where people are building their health, rather than just treating sickness. “Many people complain that they are in a hospital and have heart disease, but they go down to get something for lunch and there is an oil deep fryer at the food stall, and that’s all there is to eat,” she says. “Our department works with the food service directors to make changes, installing an air fryer for example. There have been a lot of changes like this already. We have partnered with Kaleida for example, helping them become more involved with local food promotion and changing buying practices. We have worked with Roswell Park to get a composting project going, and we have worked with many more.” Marla notes that the individuals and teams within the healthcare organizations working in these areas are, “So busy, so stressed, under so many constrictions on what they can purchase, and they are often understaffed that they don’t have time to look at the bigger picture. Beth and I can help relieve that pressure and allow them look at that whole picture. We also help them go out to pursue grants and get funding to speed them towards reaching their goals.”

Locally-sourced food in WNYTo make all this happen, these two deeply knowledgeable and passionate dietitians are focusing on an important initiative called “Food is Medicine.” To better adapt this originally West Coast-based initiative for the WNY community, Marla explains that, like elsewhere, there are food access and food security issues for many neighborhoods here. However, Marla adds that with Buffalo’s weather and food culture, “We can’t just bring in something from the West Coast because we are not going to get good adoption here. We have to try to meet people where they are at. Therefore, we work alongside a lot of different local Western New York partners together with national partners.” She notes their work in adapting programs like the Healthy Corner Store Initiative from the nonprofit Food Trust organization that developed in places like Pennsylvania and New Jersey, which is now spreading across the country to bring healthier options into small bodegas and grocery stores that might be the only source of food in some Western New York, neighborhoods. She says, “While we are the Medical Campus, we must always be thinking of that 80%,” explaining that these are some of the programs that can make a real impact. Beth added, “Buffalo is one of the most segregated cities in the country, and the way that food is distributed is not equitable. Communities of color here don’t have as much access to grocery stores as they do to corner stores..”

“In the food system itself every meeting is like a family reunion.”

Looking at Western New York’s food system from a larger perspective, while segregated and challenging, especially in terms of wellness, there are still many unique opportunities due to a number of factors not found elsewhere. Not the least of these is the way that people in the area work so well together to meet community health goals…that City of Good Neighbors concept really coming through in a meaningful way, neighborhood by neighborhood.

With a telling smile, Beth explains, “In the food system itself every meeting is like a family reunion. Everybody knows everybody and we are all working on similar initiatives. For instance, the same people on the Food Policy Council are on the Healthy Corner Store Initiative, are on the Local Food Action Planning Committee, and are active in other groups. We have very strong networks and social ties with lots of social capital. That’s a major asset towards addressing our community health needs.” Marla adds that the work of the Strategic Health Initiatives department at BNMC fits in well as it stimulates collaborative efforts across so many groups, such as hosting work councils, a newly forming Food is Medicine coalition, and their unique position to foster ties between nonprofit organizations working in this area together with the many leading healthcare organizations on the Medical Campus, as well as the many companies associated with the Innovation Center. Beth adds, “Integrating networks is one of the most valuable things you can do to accelerate progress on these important projects.”

Although integration and collaboration work may sound not so difficult, there are many challenges in the difficult job of promoting understanding and empathy for such an important issue as healthy, locally-sourced nutrition for individuals throughout the community that need it most. Marla noted one larger Group Purchasing Organization (GPO), with a tremendous footprint within the community in terms of food distribution to WNY healthcare facilities, was very difficult to access at first. She explained that once contracts are signed, “Many times healthcare institutions are completely beholden to these GPOs. They have to buy something like 90% of all items they are purchasing from these GPOs only, everything from rubber gloves to potatoes.”

“It was a huge win!”

Running up against a wall, Marla and Beth worked hard on knocking it down. Marla says, “We searched through LinkedIn and contacted many folks until we found someone within the company who turned out to be very understanding. We had an initial conversation, and the individual became very excited. Eventually, he become a true driven champion that brought together a number of parties from places like Roswell Park, Jericho Road, some groups in Rochester and elsewhere throughout Western New York,” together with leaders from his GPO that also quickly began buying in, ultimately improving the healthy food offerings and quality for tremendous numbers of patients across many facilities. Sitting together with these groups, working closely and carefully through all the complex issues, Marla, Beth and their team overcame the challenges, ultimately getting the hyper price-conscious GPO and healthcare facilities to radically change their food offerings by buying healthy local foods. With buy in achieved and everyone on the same page through their sheer tenacity, Marla and Beth worked up a model proposal with the large GPO that was hyper-local, ensuring it would source locally produced WNY foods, all with accountability and traceability. The GPO agreed to significantly fund a proposal for the program to be put up for bid. Marla and Beth both exclaimed, “It was a huge win!”

The Medical Campus team didn’t stop there, but rather made sure to try and shepherd the program through to success. However, Beth and Marla soon ran into even higher, thicker walls. Marla says, “At that point, we then invited our other large network of community activists, farmers, and others into the discussion.” Educating these local players about the program, Marla and Beth asked the GPO to formally invite them all to bid. When a local farmer won the bid, everyone was elated. It was at this point, though, that one Buffalo urban farmer activist mentioned to Marla and Beth that they didn’t receive the original RFP at all. It immediately became clear that several other interested farmers were also apparently overlooked. Marla says, “We got the program going and thought the RFP was going out to everyone involved,” but she later found out that it was awarded only after the request went out to very specific parties on a list of people with which the GPO already had prior relationships. “Not everyone in the community was included in the process,” Beth says. “Here we were, so excited about the program, talking about equity, diversity, minority women-owned businesses getting opportunities, and it turns out they never even got a crack at it,” added Marla.

Reflecting on the experience, Marla relates, “Transparency is an issue. Organizations want to keep certain records and processes to themselves and that’s where we miss the boat sometimes when the process isn’t transparent enough.” Empathizing with the farmer that missed out on the RFP, Marla asked the individual to speak out at the next meeting, telling him, “This is your space to talk.” She wanted to make sure to let everyone involved hear his voice so as to make the process more transparent and more successful next time around, hopefully creating an even better model of community collaboration for all involved. Thinking about these walls and challenges whereby healthy, locally-sourced good food doesn’t always get to the individuals that need it, or come from the individuals who should be producing it, Beth says, “It’s the system.” She explains, “The food systems change all the time, and it is not something that can be fixed overnight. It takes long-term strategies and constant work, blood, sweat, and tears over time to eventually make progress in these areas. That’s what hard, but someone’s got to do it.”

“Connecting the dots and bringing these best practices to the fore for more people is really our role.”

Listening to their strong desire to improve the system, it becomes instantly clear we should all feel lucky such talented, passionate, and driven individuals like Marla, Beth, and the Health and Well-being team at BNMC, are the ones willing to put in that hard work on behalf of all of us in the Western New York community, benefitting patients, business, and individuals alike to have healthier outcomes all around.

“All the work we do with the Food is Medicine coalition is to bring food to the people that need it the most in a healthy living way. This is the endgame,” says Marla. The Food is Medicine movement has been going quite on a while nationally, she says, but it is not just about healthcare. It is about health generally at many levels throughout the community and along the food chain. Marla says there are so many definitions that it is hard to target because it is such a large concept. The idea of Food is Medicine may be easier to understand through examples. She mentions that there are grassroots nonprofits, like Allison DeHonney’s Urban Fruits and Veggies, LLC, which is an urban farm business that works alongside the US Department of Health and Human Services-funded Community Health Center of Buffalo, Inc. (CHCB) led by their CEO, Dr. LaVonne Ansari. These partners set up an innovative ‘food prescription’ program. Marla explains, “Allison comes to CHCB with her mobile truck of fresh healthy food and the doctors from the Center give out funded ‘prescriptions’ for people that might be pre-diabetic and need to eat more fresh vegetables to go get them from the truck, which is right there.” The ‘prescription’ serves as real money vouchers towards these healthy food purchases, along with good education on healthier food habits. Marla notes, “These smaller groups can really make a difference on the ground while we in BNMC’s Strategic Health Initiatives can bring these connections together and demonstrate this to many more.” Beth adds, “Others may not be aware of these programs, so connecting the dots and bringing these best practices to the fore for more people is really our role.”

To this end, Marla and Beth’s team at BNMC are hosting here in Buffalo a Food is Medicine Symposium on Saturday October 16, bringing in a range of nationally recognized experts with decades of experience in medically tailored meals, nonprofits, doctors doing research in this area, and members of the national Food is Medicine Coalition. The Coalition is a strong voice that works on US food policy, such as an upcoming bill they have sponsored focusing on social determinants of health. Marla excitedly explains, “We are bringing in the national voices and pairing them alongside our local champions, and then inviting as many people as we possibly can to the Campus.” BNMC will focus on things like medically-tailored meals and the ‘food prescription’ program. Beth adds, “The purpose is to let local clinicians learn and adopt both local and national best practices.” They point out that research shows the clear benefits of such programs towards patient health outcomes. The symposium will help introduce these benefits to the Western New York community, especially the return on investment (ROI) of implementing these programs for groups like AIDS patients, cancer patients, and others. Beth further states, “A lot of people that have chronic disease are food insecure, so with food initiatives you want that triple duty of addressing the co-existence of obesity, food insecurity, and the environmental implications, as our conventional food system is so resource intensive on the environment. By using local food, addressing food insecurity and chronic disease, you are really hitting all three of those tiers.”

Hosting this symposium for the first time here in Buffalo, Marla feels that it will show how driven and resourceful Western New Yorkers can be when they have their mind set on improving outcomes for their fellow community members. She uses the word “scrappy” saying that Buffalonians really want to do a lot of great things in these areas, but sometimes need further resources and knowledge from outside to create truly unique innovations. Marla notes, “In the past, BNMC took food service directors from Western New York to Vermont to show them how hospitals look at food service there, and they were shocked.” She hopes these kinds of opportunities, like the upcoming October symposium, will light a fire for those in attendance. They hope the local leaders attending the event that will ultimately become champions working closely with all these groups, which is really what BNMC has been doing all along, bringing key people together. Marla and Beth cited their Healthy Food Steering Committee with medical experts like UB Neurosurgery’s renowned neurosurgeon, Dr. Kenneth Snyder. “We have passion and are hoping that, after this symposium, one outcome is that we can start a local Western New York Food is Medicine Coalition with folks like Dr. Snyder and others so that there’s a regular time for everyone to get together and discuss new research, advocacy, implementation, and overcoming those barriers,” says Marla.

BNMC Innovation Center

The Buffalo Niagara Medical Campus’ Innovation Center

Marla and Beth also described their very own truly innovative Food is Medicine research project at BNMC which they hope to highlight to others at the upcoming symposium. Their program is funded by Highmark Blue Cross Blue Shield and currently ongoing. The project takes 125 participants, ½ healthcare workers and ½ nearby neighborhood residents, most with pre-diabetes, high blood pressure or other health issues and provides them with 2 tailored healthy meals a day, 5 days a week for 6 weeks. “We are providing cooking education, nutrition classes, mindfulness practices and more as we take a holistic approach. Beth explains, “The goal is to create sustainable lifestyle change through holistic support by focusing on the ‘how,’ to implement healthier living altogether, not just focusing on meals.” Participants need to learn the mindfulness techniques, which Beth admits won’t change their medical condition overnight, but hopefully will eventually lead to sustained lifestyle changes that will ultimately produce positive healthier outcomes for these individuals. There is even an RFP being developed for a software app that will send the group tailored messaging and that tracks compliance data. Demonstrating these cutting-edge collaborative techniques can be done through BNMC’s resources like the Innovation Center, which is a living lab with physical space for businesses, not only healthcare ones, to test out what they are working on and gain from the innovative ‘collisions’ that happen among Buffalo’s leaders in tech, social enterprise, and other sectors, all helping each other out. The Center houses teaching rooms, podcast facilities, and resources for any company that wishes to come in. Currently, two big programs this year at the Innovation Center are called “EforAll–entrepeneurship for all,” and “Eforever-entrepreneurs forever,” which are national programs that include mentorship opportunities for the local business community here. The Innovation Center provides Marla and Beth with direct access to diverse groups of incredibly innovative thinkers right in downtown Buffalo, in their own office building, to help bolster their program. “Eventually we hope to get more funding to create a model that we can really scale and replicate across the community together with other health systems. We would love to have a wellness center right here on the Medical Campus where we can have a teaching kitchen, garden, and hub for all the organizations to use,” says Beth.

The most important thing, Marla and Beth feel, is to be communicating effectively with stakeholders across all these areas, whether transportation, food access, food production, economic development, and more so that both institutions and private practices learn the best practices from local leaders as well as nationally. Marla explains that she is a part of Leadership Buffalo, which is an organization that strives to make Buffalo better bringing more awareness to leaders about our community through engagement, breaking down Western New York into different areas such as healthcare, transportation, economic development and more. They bring in executives from many different sectors to do volunteer work to work in places like the Seneca-Babcock neighborhood, making a difference on the ground. Organizations like this try to break down the silos that Buffalo presents, neighborhood to neighborhood. Yet, this takes time and greater awareness. “There are a lot of people that have no idea about these neighborhoods and how important it is to work with them,” Marla says. “We are a very segregated city, but we also have a percentage of the population that can live at a good standard of living, enjoying that fruit, living on lake Erie with great architecture and affordable housing, but they don’t see that we are one of the poorest cities in the nation. Often, they don’t see, like really see it, it because they don’t go outside of the Main Street area or Elmwood Village. This is not to judge, it is just the way that it is, people lack that awareness,” says Marla. “It’s not a great place for everyone,” Beth notes.

When asked about the challenges specific to Western New York when trying to meet these goals, Marla notes that it depends on how we are comparing to the rest or the country. She says, “We actually have a national organization we work with to reach these goals called Healthcare Without Harm, which works with hospitals throughout the country. We have found in working with them that there are initiatives from hospitals which tend to start on the East Coast and West Coast, that then flow-in to us here in Buffalo. Because of the Innovation Center, we have a number of huge thinkers that can find the best practices and accelerate the process so that we are not waiting, implementing those models here in Western New York.” Beth adds, “We are a little bit behind here in Buffalo compared to the West Coast and New England, where they tend to be more out front on these initiatives, but I think that is to our advantage.” She notes, “We are home to the chicken wing and beef on weck, which is our culture, and we have a lot of sick people in this area in terms of population. In Erie county we are doing a bit better after being ranked 52 out of 62 counties in New York state for health outcomes, but that is still very low, so there is a huge opportunity to make this work. That’s why we need these grants to help change the culture for our wellbeing, economy and productivity.” This means there is great opportunity, with Marla and Beth certainly up to the challenge. “We will forever be employed working on these issues because there is a huge opportunity and a huge strength here.”

“I am so excited about the impact that all these collaborative groups will have on our community. I know it is cliché to say, but you can’t do anything alone.”

Reflecting on what BNMC’s Health and Well-being team would like to achieve in the future, Marla says, “The roots we are putting in are so strong, I would just love to see the strength of the community work to make sure these things are sustained, having all the partnerships come together to make sure these programs become a natural part of our city and region. It’s all about collaboration, connection, strength and sustainability.” Beth adds, “Youth are a big part of it too. We have youth grow up in our area maybe never having eaten a grape or watermelon. People don’t realize the magnitude of the issue. In the future, if we can spread these initiatives to people that need them the most, that will have the greatest impact on the health of our region. I would love to see us reaching more and more of those populations with everything we do.”

To make all these dreams come true in Western New York, both Marla and Beth say the most important thing is the need for even greater collaboration. “I am so excited about the impact that all these collaborative groups will have on our community. I know it is cliché to say, but you can’t do anything alone, you have to work together, and I feel very strongly about that,” says Beth. “We always talk about the importance of breaking bread with people, having doctors and farmers and others sitting alongside each other and really listening to each other, because on the ground is where those important learnings happen, where the empathy comes. I have the greatest respect for people on the ground and we at BNMC’s Strategic Health Initiatives department can provide a voice for those individuals at a larger table, while getting the corporate stakeholders out of the boardroom, doing healthy activities together, building trust and working to get everybody collaborating,” says Marla proudly. “We need to do more of that says Beth.”

Just reviewing the breathtaking amount of work that has been done by Marla, Beth and their BNMC team to help all of us in Western New York achieve better health, it is an easy bet that the roots they have laid will bear fruit — healthy, local, high-quality fruit — well into the future.

(by Alan Kahn, HEF Communications Committee Chair)