podcasts

Health Equity Focus with Arti Chandra, MD, MPH

We welcome Arti Chandra, MD, MPH, who will be discussing the issue of food security and access to healthy foods through community-based programs. Blending her passion for social activism with her background as a Functional Medicine practitioner, Dr. Chandra has been involved with numerous public health campaigns in the US and internationally, aimed at improving health and vitality through nutrition.

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Transcript:

Kalea Wattles, ND:

Today on Pathways to Wellbeing, we welcome Dr. Arti Chandra to discuss the link between food insecurity and chronic illness.

Dr. Chandra was among the very first class of IFM Certified Practitioners. She’s also a board certified doctor in integrative medicine, holds a master’s degree in public health, and has practiced for over 25 years as an integrative family physician. She’s now shifting some of her focus toward food equity and sustainable agriculture as root cause approaches to creating a healthier population and planet. So welcome, Dr. Chandra. We’re so excited to speak with you today about the great work that you’re doing to advance public health and hopefully get some takeaways for our listeners to put into practice in their own lives and community. Thank you for being with us.

Arti Chandra, MD, MPH:

I’m thrilled to be here. This is going to be fun, and I appreciate the invitation.

Kalea Wattles:

Well, the pandemic that we are currently in has really shed light on many systemic issues in the United States. One of them being access to health care in general, and then the issue of food security and navigating this new normal situation. For a lot of people, accessing food has become that much more difficult. Communities that were already struggling to stay healthy are becoming increasingly burdened and affected by what’s going on in the world. So with your varied experiences that you’ve had working with underserved communities and their unique health issues, can you share with us a bit about your thoughts on the current state of health equity in relation to food insecurity?

Arti Chandra:

Absolutely. And Kalea, we know that this is a very big topic and one that really, fortunately has been thrust with a desperate cry out into the consciousness of American society. Unlike, I think, at any time before, and this is, of course, due in large part to the injustices that have been illuminated through the brutal killings of George Floyd and others, as well as through the COVID-19 pandemic. We know this pandemic has put a large and very bright spotlight onto the disproportionate vulnerabilities and suffering that decades and centuries of systems that lock people into poverty and poor food access. And we have to speak about race in this country if we are to effectively address the health and food inequities that exist.

We need to keep in mind that race is really a social construct; it’s not a biologic construct. We are not physiologically or genetically very different from each other, really about 99 plus percent the same genetically. But we are socially and politically different because of the systems that have separated us. So starting to examine this on many different levels, we see that in prior protests in our history, it was mostly the Black community engaging in those. White people were not really participating. But now we’re seeing the white and privileged Asian, South Asian, communities also joining in. And from speaking with some Black activists in our area, this is all giving hope to the Black community.

And it’s an undeniable wake up call for all of us, I feel. It’s a particular call to action, actually, for healthcare providers of all types to step into the game of trying to dismantle these systems. And I have to say here, just briefly, that it is great to see IFM stepping up and out with this declaration to be part of the solution, and not just with changing the medicine that we’re delivering, but also to be actually moving into part of the systems change at the level of social determinants of health that are needed, and also with access to lower income communities for Functional Medicine care.

So hats off to Amy Mack and the IFM leadership team, and the board and all the staff, for leaning in to find ways we can all work together to shift the change. I’ve been having conversations for years with Dan Lukaczer, Mark Hyman, Patrick Hanaway—and everyone shares this vision and this goal, this commitment. Then Robert Luby came on board some years ago, and he and I actually went to the same inner city residency program, and he went on for decades to work in underserved communities.

IFM is well positioned with great leadership around this and is now finally at the table in the healthcare arena with a position to take on this. So I think the time is right, and I’m very excited to see what we can do together.

This is certainly extremely important work. And what I can say organization-wide here at IFM, we now have a Black Lives Matter Action Force, and we’re really recognizing that we’re uniquely suited to meet the needs of this community. But as we do this work, we’re realizing the size and complexity of the work that needs to be done. And that can be somewhat daunting. From your perspective, knowing the huge scope of these issues, what’s the best to get started doing this work?

Well, starting with the size and the depth of the problem can really feel daunting. And if we just start with the numbers—and I feel it’s particularly important that if we’ve been talking about the numbers, that we don’t just hear them as kind of sums or quantities, but that we recognize them as individual and collective sufferings for the issues at hand and the people affected. So we’re talking 40 million children, women, and men living in poverty, we’re talking 600,000 children, women, and men who are homeless, we’re talking 28 million children, women, and men who are uninsured and 37 million Americans struggling with food insecurity, otherwise known as hunger or basically the same as the number living in poverty. And, of course, due to the pandemic, we know all of these numbers, and the folks that are experiencing these are rising.

So reflecting on these, what do we know about the public health literature on this? I think it’s important. It clearly demonstrates that health disparities exist due to the systemic and structural policies that kind of lock poverty into place. It’s been centuries of a lockdown for these communities. The literature demonstrates also that it’s institutional racism that leads to significantly higher rates of communicable and non-communicable diseases, as well as trauma in all of its forms, which, of course, as we know from systems science, further leads to more disease. So it’s a really vicious cycle, an unnecessary vicious cycle that leads to perpetuation of suffering. We know, per USDA literature, that 14.3 million households in this country had difficulty providing enough food for the members living in these homes. And when food is available, it’s devoid or severely lacking in essential nutrients for the proper biochemical functioning that we understand. And each of these human bodies are affected.

And there’s a quote, actually, that I wanted to share that has guided me in my thinking a bit. It was stated by a French gastronomist back in 1825, Brillat-Savarin. And he said that “The destiny of nations depends upon the manner in which they feed themselves.” This is so in our face presently. I mean, look at this destiny that we have arrived at nationally by turning away from—even if you just look at the last several decades, let alone centuries—from the root causes of poverty, racism, and food security in the lives of these 40 million fellow humans. We are now drowning in disease burden and suffering disasters—including economic disasters—because of this neglect. And it’s largely been set up by design.

So with this economic collapse that we can be headed for, we really need to turn this ship around. And again, I feel that we in the functional and integrative medicine space, we’re very well positioned as thought and clinical leaders to help steer the ship in the right direction, by our engagements at almost any level.

Kalea Wattles:

That’s very profound to think about the destiny that we’re creating. And I am hopeful that our community can help turn the ship around, as you said. Because as a parent of young children and thinking about the devastating effects of systemic and racial injustices that keeps healthy foods away from families and communities, and knowing that there are parents like me out there who have children that are going hungry at night, it’s just… You said you invited us to feel those statistics, and as you were listing those numbers, it’s painful. I think that’s the feeling I was having is it’s painful to hear that.

Arti Chandra:

Yeah. I so agree, Kalea. We have to see ourselves as a human family and move in on these issues as we would for our own families. I mean, with food insecurity, I think about two types of malnutrition that we are fostering in our country. First, there’s the under-consumptive malnutrition, meaning depriving folks of essential nutrients, as I mentioned, the nutrients needed for proper biochemical functioning. And that’s happening by way of these fake, nutrient-depleted foods that we’re forcing into their communities. And on the other side of the coin, since the 70s and 80s, thanks to the food industry taking over our palates and our purchase options with the introduction of high fructose corn syrup into the market, food chemicals of all sorts, gluten, soy, corn—all of these flooding the food market, we also clearly have been facing an over consumptive malnutrition via the “Standard American Diet” we call SAD, or HAD for the “Horrible American Diet.” And this is, of course, tragically illustrated in our childhood and adult obesity rates, diabetes rates, and so forth.

So there’s extensive literature that shows strong correlations between food insecurity and negative health outcomes leading to an epidemic, and actually now a pandemic, thanks to the globalization of our lovely standard diet and globalization of obesity, type two diabetes, and heart disease. And, of course, so many others. And interestingly, and not surprisingly, these are the three very conditions that are most strongly correlated with vulnerability to succumbing to COVID with notable morbidity and mortality. I mean, it’s not rocket science to make the connections between the food access our fellow humans in these impoverished communities have and their high rates of disease.

I feel that we as a functional and integrative medicine community need to heed the call to join in the work, to change the equations. And a few approaches that can highlight this, that come to my mind, is that it’s really important to start with ourselves, right? It’s important to look at what privilege we have had and examine that closely. Everything from how you’re looked at—are you judged unfairly? Are you regularly discriminated against? Also, in your education, did you have to worry about safety, fairness, access, all the way from elementary school to having access to college and to jobs? So, we know that African Americans make about one tenth the amount of what the white community makes, and Latinx and Native American communities are not much higher than that. So it’s really important that we look at these in a way to explore our own potential implicit biases in order for us to better engage.

The other part of it that comes to mind for me is that we are seeing some changes in the medical systems and the political systems through what’s going on in our society since May, really, and then also since COVID has hit. For instance, the equity inclusion and diversity groups are springing up in many places, in hospital systems and corporations. And I think what’s different now, because some of these groups have been around for some years, is that leadership is actually listening. And there have been inclusion activities for years, but perhaps they’d end up being more of a lip service kind of thing. And now we’re actually seeing leaders asking for numbers, asking for approaches to take to improve these health disparities for their patients or their employees.

So, just as an example, this week at Kaiser Permanente, here in King County, near Seattle, we have a group of cardiologists that’s putting together a lecture this Thursday on coronary artery disease and racism. We’re starting to see a lot of wake up happening, and we need to connect racism with these health and food inequities, like I said, to really effectively create change.

Kalea Wattles:

Yeah, that’s the perfect lead in to my next question, because you’ve talked to us about how nutritional insufficiencies and systemic racism can perpetuate chronic disease, but in the Functional Medicine world, we also talk about how these things precede these and set us on a trajectory to either health or disease progression. So, while you were pursuing your master’s in public health, you worked on a campaign with Cambodian refugees in inner city Chicago. And then later, as a family physician, worked with poor Black communities focusing on maternal and child health concerns. I’d love to hear a little bit about those experiences and the issues around prenatal and early childhood nutrition that you witnessed when you were working with these populations.

Arti Chandra:

Yeah. I’m happy to share about that. I’ll have to say, it’s pretty heartbreaking that we’re still talking about these same issues. This was back in the 80s that I was engaged in this. And we had some hope then, but what was lacking was the political and healthcare system will to make changes for these communities. And again, we’re seeing maybe some hope that things may shift better now. I just needed to say that when I think back and think about for how long that I’ve just been involved in this, it can feel kind of sad, but it’s great to feel this hope and see some change happening. I’ve had a passion for health justice since my college activism days in the 80s. I found myself always drawn to the maternal and child health needs with activism work, and the divestment movement in South Africa, with work in Guatemala and Nicaragua, also some work in India and then with the poor in this country.

I was reading books by Frances Moore Lappé and other books around healthy eating, the environment, the planet. And I worked at a food co-op and started learning about the negative effects of big agriculture and the benefits of home gardens and small local farms. So all of those seeds were getting planted. In fact, somehow I wrote my freshman rhetoric paper on the negative effects of the American food system. And the first line of the paper was, “If the saying you are what you eat is true, then Americans are in for some big trouble.” And I just find that kind of funny that we’re still talking about this, cautioning patients, “You are what you eat.” And we understand that biochemically, that there’s a lot of truth to that.

This quote actually emerged from the same gastronomist that I quoted earlier, where he said, “Tell me what you eat, and I will tell you who you are.” We know this to be so true in our root cause approach to health and disease. And we see daily in our practice that the diet of wholesome, varied, real foods from the Earth helps to create health and well-being, and while diets made up of fake, SAD foods are primary drivers of chronic disease. We know that a couple of years ago, the count was about 12 million children living in property, which is about one in six kids. And, of course, the numbers are increasing. We’ve known now for decades how poverty can so negatively impact the physical, emotional, psychologic, neurologic, immunologic aspect of children’s lives, not to mention the spirit and aspiration aspects for them. And we know that investing early can save a lot of lives, suffering, and costs later.

For every dollar spent, and I learned this also back in public health school, and the figures have changed, but generally the proportions are similar: that for every dollar spent, there is a later $17 to $35 savings on those later disease and social impact costs. But we don’t really move toward these investments. And we can say, I think with heartbreaking clarity, that we are abandoning the potentials of a huge, unacceptable percentage of our children’s lives and who are, of course, future adults. You mentioned my work in maternal-child health with the Cambodian refugee population. And through this, I saw firsthand how unhealthy food, more than poverty itself, leads to a vast array of health problems for both the mothers and their children.

This is a population like many others where in their home country, they were poor, but actually had access to a traditional plant-rich diet without these modern chronic diseases. But upon arriving here and being thrust into our food system, we were seeing obesity emerging. We were seeing other conditions of inflammation. And what we focused on was the very poor dental situation for infants, even without teeth, they had the nursing carries or nursing cavities as well as children with cavities at very, very high rates. And this was, of course, due to all the sugary juices and snacks and so forth that were being regularly fed to these children due to that was what was accessible, that was what was affordable.

For me, there was a great learning here on some of the three most important forces that influence food in these communities. First, what comes to mind is the marketing and ad campaigns in our society that make cheap and fake food seem flashy and attractive. And the next is the Farm Bill, which basically makes these fake foods very affordable. They’re the cheapest foods available. And the third is related, where there was simply a lack of available healthy foods for these communities to buy. These all came together to show how a community without prior chronic disease can turn very rapidly into almost a poster child for these issues.

Then I worked for about 15 years total in inner city Black communities in Chicago, and then in Seattle, mostly doing high-risk obstetrics and prenatal care work. Their preconception—prenatally we know that the mother’s diet affects everything from her gut microbiome, her hormone balance, her fertility issues. And then moving into things like gestational diabetes risk, pre-term labor risk, low birth weight risks, preeclampsia. And these are just to name a handful of some of the morbidity issues that can be directly related to food insecurity. Of course, other things are involved, other stressors and environmental toxins, but food is a huge one.

For the baby and child, poor nutrition leads to very elevated risks of a whole host of conditions. We know that from our systems biology understanding about the powerful and critical role of diet on every single biochemical process in the body. We know that the negative impact of sugar and the lack of essential nutrients consistently can lead to dysfunction in all these biochemical pathways, enzymatic pathways, immune function for the child and this future adult. Of course, now we know so much more about the oral and gut microbiome and the significant role they play in all the mechanisms running our body toward either health or disease. The microbiome is involved, at least in part, in almost any disease. And all the insults that folks in impoverished communities have impacts their gut microbiome negatively.

Kalea Wattles:

I think something that is particularly powerful and makes many of us feel this call to action to intervene is knowing that there’s these sequelae of nutritional insufficiencies that really last a lifetime.

Well, I think you’ve beautifully highlighted how Functional Medicine allows us to look at patients as whole people with a vast array of determinants of health. How does your training in Functional Medicine shape the way that you address the link between health disparities and food access to overall health and well-being? How do we link that food insecurity piece to chronic disease over a lifetime?

Arti Chandra:

I guess my first thought on that is the overall Functional Medicine approach, which is really systems biology, systems thinking—and a deep bow of thanks to Jeff Bland and other IFM leaders for teaching us about this and how critical it is to working with an individual patient to understand what is going on in their body so that we can help them move toward greater health. But the funny thing about the systems thinking, as you may experience yourself, Kalea, is that you sort of ended up applying it in all different aspects of your life. It’s hard to not think systems-wise. And it’s clearly how I’ve moved into, with greater

passion now in the current environment, to what’s going on with race and health inequities. And so it’s almost like seeing race, food insecurity, poverty, health disparities as a patient, as the system that we’re working with.

And we want to apply our Functional Medicine Timeline to it. We want to apply our Functional Medicine Matrix to find those root causes, understand their linkages. And again, try to restore this system back to kind of optimal functioning and well-being. We’re really well suited to move into this space and try to turn the ship around, as I said. And you mentioned the timeline earlier. And typically, in our one-to-one work, we cultivate this listening. We’re listening to the patient’s whole story to see what the patterns are, to see what the clues may be on their trail to disease. A key element of our work is this deep listening and the attention to the detail. And we can certainly apply this to working societally, working in our communities around these issues.

We’re seeing this rise up and this call for action, as we talked about. These are desperate calls and desperate teachings from the community about what they are going through, what is really going on. So even if we can apply that deep listening to these stories and move forward in almost like a therapeutic relationship with this system of inequity, it can help us move into right action to help ameliorate these issues. This means listening also to community leaders, listening to organizations working for right action and finding ways to be helpful that are mutually beneficial ways to help achieve the community’s goals. Just as we do in the clinical setting with our patients, and we take a team-based approach with our colleagues in other fields that are relevant, such as physicians working with dieticians and social workers.

We need to do that collaboratively in the communities we want to move into, to work with breaking down these systems. So we can apply the whole matrix, actually, to what we’re doing. Daily, I have seen the disproportionate effect that the patients suffer from due to this intersection of race, poverty, and food and health insecurity. I’ve learned over time to ask my patients certain questions like, “Do you ever run out of food before your next paycheck? Can you afford to eat a balanced meal most days of the week? Do you eat less to stretch things out? Do you hold foods from your kids when you’re hungry to stretch things out? Do you own a cutting board? Do you own a cutting knife? Do you have cookware to work with?”

So looking at the matrix, we have to get to these capacities for our patients and these communities to move into healthy eating, once we can create more access for them. We can even look at things like antecedents or predisposing factors for those who may not understand that part of our tool. And antecedents here can, of course, be greed and centuries of racism, and the Farm Bill, and the food industry. Those can be background forces at play, creating the situation that these communities are in. Then there’s triggers and mediators that could be the ongoing policies and the corporate profiteering that helps to keep the system in place. Then if we look at the nodes of the matrix, there’s the immune area; for instance, immune and inflammation, what do we have?

We have diets that feed into inflammation in our body. Most meals of the day in these communities are pro-inflammatory meals. So you have chronic inflammation developing, and there’s no wonder, therefore, that there are higher rates of cancer, heart disease, obesity, just from that alone. But another node we look at in Functional Medicine is detoxification, biotransformation. We know that from the social determinants of health, that impoverished communities are often in settings where there is a lot of exposure to chemicals and food toxins, environmental chemicals, plastics, pesticides, air, and water pollution. So that’s a factor too that we can work with by having that awareness. I think another super important one is that center of the matrix, the mind-body-spirit, and really recognizing stress in all its forms in these impoverished communities and how it triggers and serves as a mediator of so much dysfunction in the body.

Again, leading to more inflammation, leading to immune weakness, immune dysfunction, psychological issues, neurologic issues. We know that stress alone can change behavior. It can lead to impulsivity. It can lead to less healthy food choices in and of itself, like I mentioned, lead to inflammation, which then can lead to more stress, and so on and so on. So I think these are three areas of the matrix. And then, of course, there’s the bottom of our matrix, where we have the modifiable lifestyle factors, and there we’ve been focusing on food, and clearly, we know that increasing vegetables and plants in the diet decreases inflammation. It decreases oxidative stress, which can be so destructive in the body. It can decrease stress itself. It can decrease psychological issues and improve mood. We also know that improved diet helps with resilience against COVID and other infections. So I think our matrix can really be applied well into this work.

Kalea Wattles:

I think we can all hear in your voice how much this work means to you, and your path through medicine really highlights that as well. So, I understand that you’ve recently kind of pivoted your 20 plus years of practicing functional, integrative medicine at a major medical center here to focus on addressing the intersection of human health and planetary health. And that includes regenerative agriculture, approaching food as medicine, and how that could actually benefit community resources like food banks. Can you explain a little bit how this work benefits human health and planetary health? In particular, the food insecurity that we’ve been talking about?

Arti Chandra:

It’s really become a newfound passion and commitment for me. It’s part of the reason I left the medical practice I’ve been in for the last 15 plus years. Basically, what started happening for me is thinking about the crisis we’re in, for our planet, and knowing what all the issues are there—what are the issues involved in destroying our planet? And then recognizing that these are the same issues that we’re talking to with each patient every day about lowering toxins, about eating organic as much as possible, about working with the gut microbiome as best as possible. So I started learning more about regenerative agriculture and planetary health and the interconnectedness of those.

I’ll share one more quote as I talk about this by philosopher and farmer Wendell Berry where he said, “The soil is the great connector of our lives, it is the source and the destination of us all.” And it is really, really so true. What’s happened is that our industrial agriculture practices for so many years now, for so many decades have effectively destroyed our soil. If you think about the acreage on the planet that is using these destructive methods, it’s the vast majority of land mass that’s being used for agriculture. So we know that the impact there is that instead of healthy soil sequestering carbon from the atmosphere—and that’s the natural course of events that happens, it’s not doing that.

And that has to do with things like tilling the soil that exposes carbon and life forms to oxygen, which then releases the soil carbon into the atmosphere as carbon dioxide. It’s using fertilizers and pesticides with no abandon to solve every single problem of agriculture. This can, of course, also cause a release of excess greenhouse gas emissions partly by killing the healthy microbes in the soil that actually build and maintain the soil and help to sequester carbon. We end up with these barren fields and fields of dead soil that then emits more carbon, and all those living organisms that are in there are no longer there. So there’s all sorts of practices—overgrazing, clear cutting, not allowing a variation in grazing by animals, and so forth—that are creating this problem.

We basically have a problem of much more carbon in our atmosphere from this farming methodology that we’ve had for decades and decades now. What’s known now is that there are really significant nutrient losses. For example, I heard a quote recently that “They can take 72 bowls of today’s spinach to equal the iron content to just a few bowls of spinach back in the 1940s,” right? The food that we’re eating is depleted of essential elements, essential nutrients that drive our biochemical pathways and help support health in our bodies. It turns out agriculture adds up the carbon emitted, adds up to more than the world’s cars, planes, and trains combined. So it’s a huge issue, and apparently, our current food system is responsible for 44% or 50% of all global greenhouse gas emissions.

Regenerative agriculture brings in traditional farming techniques. It brings back the richness and diversity of the soil, it allows the soil to sequester carbon and turn it into nutrients to help them feed our plants, to support the vast microbiome of the soil that then translates into our bodies to feed our microbiome. So I’m very inspired to do this work because it is really critical. We’re at a critical point planetary wise and human health wise. So finding ways to work with this intersection is kind of what I’m up to when I’m on this sabbatical right now.

One exciting thing is that there are more and more corporations starting to look at this. It’s probably a PR thing for them, but also healthier soils lead to better yields. For instance, General Mills is committing to advanced regenerative agriculture practices on a million acres by the year 2030, and I think other companies are following suit. So one of the collaborations I’ve made is working with an entity from southern California, where Erik Cutter and Alegría Fresh and their team have developed above ground growing systems using supercharged regenerative soil. These are growing systems that can be thrown on to any abandoned parking lot. There can be a greenhouse component depending on the climate. And what it allows for is the supercharged vegetables to be grown, fresh, local, organic, and then it’s deliverable to the food bank right there, or other places in the neighborhood where people get their food. The nutrient density is greater than almost anything you can get.

So it’s a really great concept, and we’re looking at creating educational programs, culinary education programs, because there’ll be a kind of a partnering teaching kitchen at these sites to help people learn how to work with these foods, with recipes and so forth. So I’m very, very excited about that, and I hope others will join in. There’s a lot going on in this space and a lot of opportunity here.

Kalea Wattles

Well, that is so exciting. And as you were speaking, I read a quote at some point that said, “We’re not separate. Humans are not separate from the Earth, we are the Earth.” So speaking about Earth’s microbiome and reflecting in our microbiome, I think that that’s so true. The work that you’re doing is so exciting and so powerful and so needed. So we can give our listeners some action items, how might Functional Medicine clinicians who are not currently working in community-based programs, how can we increase the racial and socioeconomic diversity of our patient populations? I would love to know, from your perspective, what are some steps that clinicians can take to get more involved in this community health that we know is so important from what we’ve talked about?

Arti Chandra:

There’s a huge range of ways to get involved. And I’m thinking of myself as well as colleagues of mine in Functional Medicine who are reaching out for new opportunities. Some of them can be just making the decision to see one, let’s say, Medicaid patient per month or per week even. Some people are looking at getting their higher income patients to help support almost a scholarship-type approach to working with interested patients from that community. This patient can be added at the end of the day, so it is kind of more on your time, for instance, since there won’t be direct reimbursement necessarily, unless there is some sort of fund for that. So that’s one way.

But there’s so many other ways to get in on more of the population-health level in these communities. One of the things that I’ve done is I’ve worked and partnered with a dietician, fermented foods person, as well as a chef and other dieticians where we do a pop-up teaching class. It could be done in a waiting room, and it can be a whole host of topics around healthy eating and healthy foods. We know there’s a whole movement of that going on. Harvard has a program that people can look up called “Healthy Kitchens, Healthy Lives.” There’s also a teaching kitchen collaborative under that. So there’s communities all over the country engaging in this. But ours was focused on the microbiome, where I gave kind of the didactic part on what is the microbiome, how is it negatively influenced, how is it positively influenced, how does it relate to health and disease?

And then we broke into chopping up cabbage and creating this very cheap but very health supportive food of sauerkraut. We also taught people how to work with it and hide it in recipes and stick it in other foods so that you don’t feel you’re sitting there eating sauerkraut all day long. That’s a really fun thing to do. A head of cabbage and salt is a pretty cheap way to go. So ideas like that, I think, are important to do, bringing those to the YMCA, bringing talks, group classes, to places of worship and working with community organizations that are engaged in these processes and seeing what they need from you.

And then there’s a level on policy, right? I know physicians, at least, have historically been more armchair activists, maybe signing some petitions here and there. But there’s ways to engage with organizations as a clinic staff, bringing community leaders in to speak to your clinic, asking patients who are of low income status to inform you more about what’s going on in their communities, working with city, state, county programs and going and participating, testifying at hearings and giving that voice. We have the ability to speak to the interconnectedness, so that’s why I think ours is particularly strong.

And there’s so many resources out there also for us. There’s Integrative Medicine for the Underserved, you can go to IM4US.org. IFM has partnered with them on several occasions. It was one of the places where I taught this microbiome cabbage class. There’s looking at IFM Toolkit handouts. There’s looking at Dr. Deanna Minich’s work on eating the rainbow. She has a toolkit and a lot of resources available. There’s an eBook, free eBook called Eating Healthy on a Budget. Then there’s programs all around the country that are already engaging in this.

Many of you may know about the VA Whole Health System, where integrative medicine approaches are being applied in many different ways within the VA System and proving to be both health-outcomes positive and cost positive. They also even have a kind of peer coaching program. And that’s another thing that can be done, is helping create peer coaches in communities, collaborating with dieticians and others to help teach people how to teach this information. Also, getting engaged with state professional organizations like the AFP. They are all engaging on social determinants of health and so forth. There’s reading Mark Hyman’s book, the Food Fix. I should make a shout out for one of our IFM educators, David Haase, who has started a nonprofit farm to teach youth how to engage in the land, and now it’s actually spread into many other projects. And to Dr. Geeta Maker-Clark in Chicago, who is working with African American women chefs and working with school food programs, the Montessori education program, and working with the families to help create fresh, healing foods for them, as well as some culinary teaching.

You can look at Zach Bush’s Organization, The Farmer’s Footprint, as well as another nonprofit that he’s about to launch, which is going to be all about helping farmers convert their land to sustainable agriculture, regenerative agriculture approaches to help both people and the planet. So there are numerous ways to get involved and engage. First and foremost, again, is exploring your inner self. And for that, there’s a TED Talk by David R. Williams, who’s a physician at Harvard. His talk is called “How Racism Makes Us Sick.” There’s reading a recent article in JAMA from June called “The moral determinants of health,” strongly recommend that by Donald Berwick. And Doctors for America as another site with a lot of resources for all, not just doctors.

And ultimately, voting. Voting is probably the number one thing we can do to support the issues on many levels to help reverse the inequity issues that are going on. So I guess I’ll close with… Well, I guess I want to say just also just keeping up with legislation and being aware of what’s coming up for what you can vote on. Martin Luther King said, “The time is always right to do what is right.” So I think right now the time is very right for us to engage and be a part of the solution.

Kalea Wattles:

Absolutely. The time is now. Thank you so much for this fascinating and insightful conversation. I’m so glad that we had our friend and teacher Dr. Arti Chandra here with us today. Community initiatives, those mentioned here today, can have a significant and positive impact on bringing people together and helping them make small but very important changes in their diet. Working with our practitioners on more grassroots efforts in these communities, and expanding the reach of these core tenets of Functional Medicine, is a humbling direction that The Institute for Functional Medicine is taking to advance our mission of ensuring equitable healthcare access for all. Thank you, Dr. Chandra, for being with us. It was just a pleasure to talk with you today.

Arti Chandra:

It’s been wonderful being here. Thanks so much.

Kalea Wattles:

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