I wrote about packaged-goods marketing and the impact of food on health for more than a decade, typed the words "obesity crisis" so many times I thought my fingers might bleed. But what this country needs to do to improve its health and stem the tide of rising healthcare costs became most clear to me traveling around the nation's capital on a shuttle bus with a bunch of men dressed in drag. The answer is really about love and simple human connection.
I was invited a few weeks back onto "Queen Force One," the bus filled like a clown car with dramatic men-as-fabulous-dolled-up women, by Craig Shniderman, executive director of the D.C. area non-profit Food & Friends.
It is somewhat a matter of semantics that Mr. Shniderman, along with 52 driven staffers and a rotating volunteer corps of more than 11,000, feeds roughly 1,400 people sick with HIV/AIDS or cancer three meals a day, six days a week for free. The real nourishment he and his organization provide is of the soul-building kind, offering up the idea to receivers and givers both that someone actually cares.
Mr. Shniderman's dedication was obvious from first handshake but more so as he sat at a conference table on a rainy day, shaven face upturned for the makeup artist graciously donated by MAC to transform him into Ms. Scarlet Letter for his beloved organization's 15th annual Dining Out for Life fundraiser. He poured himself into a tight red nylon dress, grey chest hair poking out, donned flats and a fabulously high platinum wig (natural looking as he had no competing hairline to contend with) and was ready to bar hop with similarly clad board members and cross-dressing friends. In four hours, the "ladies" visited 10 of the 140 participating DC restaurants that signed on to donate a portion of the day's proceeds to the cause.
Many of the men behind the glamorous women, the men who donned monikers like Betty Blue Bubbles, Hilda Seaview, Queen Bambi and Lin Quica, are supposedly shy and retiring when not in flamboyant costume. But I watched as they emerged like flowers over the course of the evening into their most comfortable free selves, appealing to crowds in each place with ribald jokes and big smiles to to put cash in envelopes provided for personal donations. The shift seemed a metaphor for Mr. Shniderman's ability to create festivity and warmth even in the face of tragic death and disease, to offer up (almost) free love as a model for what might potentially help prevent or at least mitigate the effects of illnesses he sees every day.
What Mr. Shniderman seems to know so well, deep in his stunning eyes, piercing even before eyeshadow, is that the combined power of actual nutritive food and the spiritual nourishment of neighbors caring about and understanding neighbors -- letting people be who they really are -- can save people from getting sick and, hence, save massive amounts of money in healthcare.
"Food has a deep psychological impact, and it can be poisonous or deeply restorative," Mr. Shniderman said. For it to be restorative often requires the "friends" part of the organization, what he calls the "healing ethos of community." Though some have families of their own, many meal recipients are isolated and the paid or volunteer drivers willing to step beyond the stigmatized thresholds of sickness to show they care might be the only person they see in a day. As drivers are often busy, a new volunteer phone program has been set up to be able to reach out and further build these relationships.
It is not just those already sick that gain from these connections, Mr. Shniderman said. "The volunteers themselves are improved by the experience of caring for their neighbors, it has a healing effect. Service to other people is extremely important."
Food & Friends was started at the height of the AIDS crisis in 1988 by Reverend Carla Gorrell, who began cooking meals in her church basement for neighbors to bring to neighbors wasting away in isolation.
Fast forward two decades, to a time when AIDS, sadly, is still a reality, along with a growing number of cancers and the uniquely American rise of Type 2 diabetes, and Food & Friends is now a sprawling facility off a tree-lined parkway. Whether in the form of fresh or frozen home-delivered meals or canned and dry goods recipients prepare themselves as part of Groceries to Go, the organization seeks to feed people's hunger and need for community together. It is a recipe that, if proffered as a preventative measure, pre-disease, could potentially relieve some of the country's costly healthcare burden.
Deb Shapiro, author of Your Body Speaks Your Mind and Be the Change, said, "There is absolutely no doubt that loneliness and isolation are huge causes of illness. From an evolutionary point of view, we are spiritual animals, not like other animals that go off immediately from their mother. Support by other people is an essential part of our growth."
Ms. Shapiro expressed concern over the way people live so fiercely independently in big cities especially, working under extreme pressure to make money and succeed.
"Loneliness and lack of contact really eat away at people's joy, happiness and their will to live," she said.
And, importantly, that stress over the inability to cope alone can take a heavy physical toll.
"Everything we think and feel, conscious or not, has an effect on the body, and the stress of isolation starts shutting down our systems, leading to digestive issues, heart problems, breathing problems, circulation problems, etc.," Ms. Shapiro said.
The increasing lack of love and friendship people have in their lives often is replaced by excess food, an imbalance Ms. Shapiro suggests could be mitigated by combining eating with the company of others. "The love factor would be fulfilled, and people wouldn't have to find it through food."
While combining good food with friendship, maybe even eating with others, seems a simple solution to the great influx of societal disease, Ms. Shapiro said talking about doing so is like "opening a can of worms." This isn't a problem easily solved, she said, because "The more separated and impersonal society becomes, the harder it gets for people to break through their wall of independence to acquiesce to eat with others."
The process will have to be a slow one, offering people easy ways to acclimate to communing again, Ms. Shapiro said. She sighed and, after a pause, suggested skeptically but hopefully, "Maybe street parties, street dinners?" It's as good an idea as any, communal pot-lucks where people can share food and friendship. Why not?
Paul Knutson, a former minister, is now a Mission Development Specialist for the Mid-Minnesota Family Medicine Center, part of Center Care Health System. He studies hard the social determinants of health to better understand how to cut healthcare costs and improve patient outcome simultaneously. He applauds such simple solutions.
"We have gone down a path of high science and expensive technology, where people who stand to make the most money work the hardest, and that choice, if we don't do something else, might be to our demise," Mr. Knutson said. He suggests real solutions are more likely to come from less costly less complicated non-capitalism-linked initiatives like that of Food & Friends and the similarly styled national deployment of volunteer Community Health Workers whose connections with minority and low-income healthcare recipients can greatly help decrease growing incidence of Type 2 diabetes and other costly health issues.
"People are alone, asking 'does anybody really even care about me?' and it's very unhealthy," Mr. Knutson said, noting that HIPAA privacy rules have only worsened the issue now, as local hospitals who used to reach out to church leaders or other community organizers to inform them about sick patients no longer can by law.
But Mr. Knutson is hopeful that new healthcare reforms that call for pay to be linked to healthy patient outcomes rather than services provided, experimental new P4P programs, will force healthcare providers to better partner with patients to develop workable solutions. Already, BlueCross BlueShield, through its foundation, has been pushing to develop solutions that bring communities together around health, including community gardens, food plots and bike trails, he said. But, of course, "the challenge is changing people's habits and driving them to take personal responsibility."
Mr. Shniderman, a master at providing a fun, inviting atmosphere he likens to Disneyland in an effort to keep volunteers and donors happy, offers that this is where relationships become crucial.
"When people develop trust in others, they are more compliant in their own best interest, in their own health," he said. It is the theory that personal responsibility is best fostered through a sense of community responsibility and concern.
Of course, actual nutrition cannot be dismissed in the equation of health, and community concern for the food habits of lower-income and minority groups is crucial to reduce the widespread healthcare disparities between the haves and the have-nots.
"We have to figure how to level the playing field nutritionally," said Food & Friends' development coordinator Pat Cornell who cited a recent study by DC Hunger Solutions that showed low-income areas in the District were like "food deserts," she said, "where people pick up meals from places like 7-11."
To combat the problem, Food & Friends is soliciting a major local healthcare company to donate $450,000 over a three-year period so they can newly provide fresh fruits and vegetables to its Grocery to Go recipients.
"It's been a long-standing goal for us to go beyond packaged staples," Ms. Cornell said, "but this is the first time we've talked to a corporate partner."
Timing is everything. Simple solutions like fresh fruits and vegetables together with friendship have never been more necessary.
Smiles and giggles abound as the Queens crossed the street out of the last restaurant of the evening, tripping over rarely-worn heels and joyfully clutching the donations their frolicking dress-ups had wrought. Dumplin' Honeychild ("Deputy Dumplin'" she corrected,) stood squarely, stocky frame teetering as she held up one hand to keep anxious, fast-paced motorists at bay for her friends.
Back on Queen Force One, Ms. Scarlet, soon to turn back to Craig Shniderman, leaned back and stared out from under long fake eyelashes at the remaining ladies, including Hilda Seaview, whose hand-sewn red-sequined gown I had helped zip across her broad back, around the slightly hairy chest against which lay the two halves of a nerf ball, each wrapped in dainty cotton doilies and placed inside her bra.
"Great work, Ladies," he said, tired but proud, a fearless leader if ever there was one.
I felt a great sense of hope. Maybe love, in whatever form, in whatever mode of dress, can save lives, cheaply and effectively. One thing is for sure, it will certainly make one's time on earth far more palatable.