There’s something like cognitive dissonance as I prepare my 2020 Health Populi TrendCast of what to expect in the health/care ecosystem in the new year. One of my key pillars for health-making is food-as-medicine, and that opportunity in this moment resonates in this holiday season with Dickens’ “Best of Times, Worst of Times” context-setting that kicks off Great Expectations.

In the “best of times” part of the food+health equation, we recognize the growing role of grocery stores, food-tech and food manufacturers in the health/care landscape. A current example comes from Kroger, partnering with Ascension’s health system in Tennessee, enhancing the organization’s community-based health services in communities where people live…and shop.

Kroger is collaborating with Berlin, Germany-based Infarm to launch living produce farms in stores to see how the concept catches on. This is a trend under the growing “farm-to-table” movement. I have observed this first through my involvement with Slow Food, and the zero-kilometer food movement in Italy which I covered here in Health Populi.

Kroger’s pharmacy, and retail pharmacies on competing grocery chains, are another aspect of food retailers growing their health services footprints in their stores. Every major grocer operates a pharmacy in their stores, and some do more than dispatch pills from behind the counter to deliver health care services such as medication management and population health support.

The pharmacy in another major grocery chain, Giant Eagle, launched a program using Amazon’s Alexa voice assistant to bolster patients’ medication adherence at home. Omnicell will collaborate in this program, which creates medication reminders and Rx drug refills via Amazon Echo: “Alexa, refill my prescription,” the consumer would request, initiating an e-Rx refill process at their local Giant Eagle pharmacy. Giant Eagle is the first food chain to offer this program.

We can also look to Aldi’s expansion of “fresh” in the U.S. as a value-priced grocer headquartered in Germany making deep inroads across America. One of Aldi’s on-the-ground tactics is to co-locate where optimal by Kohl’s department stores which, in turn, are allying with WW, the re-branded Weight Watchers boutiques. This alliance strategy is also part of a growing trend in health care real estate, “medtail,” where strip malls and shopping centers with empty storefronts are repurposing as health care sites. This trend is occurring from coast-to-coast and is a rational re-use of brick-and-mortar space which can also bolster local economic development for job-and-health creation.

In food-tech-health news, Teladoc announced a new program to leverage its telehealth platform to offer nutrition counseling services with registered dietitians to people seeking such support. This will be offered direct-to-consumer or as nutrition programs prescribed by health care providers, according to Teladoc’s press release. [Further details on this program can be found in the MobiHealthNews coverage on the story here].

As for the “worst of times,” at about the same time as the Kroger news hit the business press, a report on cuts to SNAP benefits from the Department of Agriculture reached political and mainstream media — from Vox and The Hill on the politics front along with NPR and local news stations — especially in rural areas that would be hard-hit by food stamp cuts in already-economically soft ex-urban economies. Here’s the rule from the USDA’s website.

The USDA cuts to SNAP could also negatively impact health citizens in the colder northern states as winter temperatures fall because the cuts also impact financial support for utilities in a section covering the Standard Utility Allowance (SUA), the Urban Institute calculated. The hardest hit states would be Vermont, New York, South Dakota and Maine – where temps grow very cold in the coming months.

Food and access to utility services are key social determinants of health, the American Academy of Family Practice has asserted.

Health Populi’s Hot Points:  When asked what type of FTE personnel their primary care practice would hire if they could add one more professional to their team, PCPs told PwC in their study, Building the Primary Care Dream Team, that individual would be a dietitian or nutritionist; in second place were mental health workers.

Teladoc’s bet on tele-nutrition gets this fact, and some of the underlying research that provided the organization’s investment in connecting patients diagnosed with chronic conditions and consumers wanting to stay healthy with nutrition. That’s because one of the most modifiable of our human behaviors is what we eat, and how much we eat.

One piece of research Teladoc pointed to in its announcement was a study from The Lewin Group on the ROI for medically-informed nutrition quantifying the health benefits accruing to veterans receiving medical nutrition therapy for patients managing cardiovascular disease.

Consumers in DIY health and medical self-care mode in fact look to food and grocery stores as touchpoints for helping them make health.

One in two Americans say that grocery stores are allies in helping them stay healthy, according to the Food Marketing Institute. That’s roughly the same proportion of consumers who look to their gyms and health clubs, and to farmers, for being allies “on my side” for health.

It’s clear that people want to engage in health via the food they buy and consume. Whether people have universal access to healthy food, and the money to pay for it, can prevent consumers from engaging in self-care in this powerful way.