Root Causes


Healing the Food System: working as health professionals to support the sustainable and humane production of food in combination with access to healthy food. The Root Causes student group was formed with one question in mind: how can we as medical students work to improve the health of Duke patients and the wider Durham community through promoting equitable access to healthy food that is sustainably and locally produced? As the obesity epidemic worsens nationally and here in North Carolina, the decisions patients make about the food they eat are more important than ever. In turn, these decisions patients make about food are driven by the ways food is produced, distributed, marketed, and sold. As unsustainable, unhealthy food finds it’s way into more and more households across America we recognize the sad truth that the food system is setting up patients to fail. Our mission is to address the root causes of this issue.

We will pursue this mission through education, service, and advocacy with an eye to policy, public health, and global health. Within these three domains, our projects have included Meatless Mondays (education), establishing a fresh produce program at Duke Outpatient Clinic to serve food insecure patients (service), legislative advocacy (advocacy), and collaboration with the Duke Healthy Campus Initiative on creating a healthier food environment at Duke (advocacy). We also plan to partner with other Duke campus food efforts, including the World Food Policy Center and other student food groups; and we plan to partner with the Durham Farm and Food Network. Through these efforts, we hope to involve the Duke medical community in improving the health of our patients and community through a stronger local food system. Root Causes was founded in 2017, and we are always looking for new leaders and new ideas – please join us because the pie always gets bigger! If you would like to get involved, email our president, Julian Xie at to get added to our listserv,, and our Facebook group.

Viewing “The Trouble with Antibiotics”, a documentary about antibiotic use in food animal production and its environmental health effects


Root Causes aims to educate medical students on food systems, food policy, and how to better approach patients about topics such as nutrition, weight loss/gain, food deserts, and other food-related issues. This would also involve education on the cultural and socio-economic factors that contribute to what people eat. We have hosted various food events with speakers and documentary viewings to discuss issues across the food system and how they all ultimately impact health. In spring 2017, this included viewing The Trouble with Antibiotics (discusses the use of antibiotics in food animals) and Fed Up (about sugar and the obesity epidemic especially among children). We also had a speaker event with Alice Ammerman, an expert on designing programs to fight food deserts.


Our first distribution for the Fresh Produce Program on Aug 25, 2017

We are engaged in the Durham community within programs that improve the food system and alleviate other health issues (eg at the intersection of food security and homelessness, access to care for chronic illnesses, etc) based on the input of students and community members. One of our near-term goals is to evaluate and subsequently improve clinical practices surrounding screening of patients for food insecurity. We hope to standardize how this is done, and then link patients to appropriate resources.

These efforts led us to develop the Duke Outpatient Clinic Fresh Produce Program, a Chancellor’s Service Fellowship project in which food insecure patients will be given bags of produce, healthy nonperishables, and nutrition education materials once a month. The food for this program will be sourced from local farms and community gardens who have surplus food, which helps them reduce waste. We held our first distribution day on Aug 25, 2017, and served food to 20 people. Getting involved with the Fresh Produce Program can also create research opportunities since we have much evaluation work to do!

We also have a relationship with the Change Center community garden, which is a faith-based garden serving low-income African American residents of the Durham West End community. The garden was created by Edwina Gabriel, the nursing director at Lincoln Community Health Center. Root Causes regularly volunteers there, and we plan to expand our involvement to help with long term projects such as building a greenhouse there.

In addition to the Fresh Produce Program and the Change Center, we have volunteered at other Durham food organizations including Meals on Wheels, and SEEDS NC community garden.

Volunteering at the Change Center Community Garden


Root Causes participates in food policy initiatives occurring in the Durham community and working with the Duke community on campus wide food policy change. This includes advocating for healthier and more sustainable food at Duke and the health center, to call for food that is healthy, sustainably and humanely produced. We will focus on getting Duke to commit to buying “less meat, better meat” as well as start up a Meatless Monday campaign. To this end, we conducted a Meatless Monday campaign within the MS1 class in March 2017.

In the future, we hope to secure commitments from Duke to buy more local food and reduce the number of soda/junk food vending machines in the hospital. These changes will send a message that Duke wants to lead by example, and since Duke is a large institution, this may translate into greater demand for local/sustainable food producers – thereby strengthening a healthier food system. With regard to these goals, we are working within the Hospital Food Environment subgroup of the Chancellor’s Healthy Campus Initiative. Our activities include working on student discounts for sustainable food, assessing the food environment in the hospital, and providing feedback to this subgroup.

In spring 2017, we advocated in the NC State Legislature for the Healthy Corner Stores Initiative in partnership with the Carolina Farm Stewardship Association and with internal medicine residents from the Duke Ambulatory Care Leadership Track. This initiative provides funding to convenience stores to implement changes that make it easier to sell healthy food (eg cold storage and shelf space for fruits and vegetables). Our efforts helped contribute to a $250,000 appropriation to continue funding the program.

Advocating for the Healthy Corner Stores Initiative


Julian Xie – President
Peter Callejo-Black – Service Leader and Fresh Produce Program Volunteer Coordinator
Josh Hayden – Service Leader
Christelle Tan – Fresh Produce Program Executive Director
Janice Wong – Fresh Produce Program Executive Director
Willis Wong – Fresh Produce Program Food Sourcing Coordinator
Micaela LaRose – Policy Advocacy Leader

Dr. Sarah Armstrong – Faculty Advisor for Chancellor’s Service Fellowship project