Food banks in the United States are busy. The Community Food Bank of Southern Arizona, which I visited last week as part of the University of Arizona’s conference on global health leadership, is helping more than 225 500 people every month. The numbers have grown dramatically with the recession. Some 16% of people in Southern Arizona live below the Federal poverty line, and one in four children in Arizona is at risk of hunger.

There is something shocking about so many people being hungry in a superpower, but food banks go back more than 20 years. They developed not because of the need, but because of oversupply of farm produce following botched farm subsidies. (This is the US equivalent of the European Union’s “butter mountain.”) The programme began as the Temporary Emergency Food Assistance Program (TEFAP) and was scheduled to end after 15 years once the oversupply had disappeared. But by the time it was supposed to end the need was so great that the programme couldn’t stop, so cleverly the T in TEFAP was changed from Temporary to The.

The heart of the food bank is a large warehouse filled with food where people queue to be given a box of food. They are given one box a month, but it contains enough food to last only for a day or two. It is a supplement. Some of the food is bought with government money but much of it is donated—by producers, shops, churches, individuals, and others. Some 90% of US lettuce and tomatoes comes into the US through Southern Arizona, and producers donate produce that has been damaged or taken too long to reach market. About half of the staff are volunteers.

People qualify for food if they have food stamps or if they declare themselves to have an income below an amount specified by the state. An advocacy unit in the food bank will help people complete the forms for food stamps and other government benefits. This can be difficult not only because all government forms are difficult but because many families in Arizona have children who are US citizens but parents who are undocumented.  If the parents complete the forms wrongly they can be deported.

The food bank I visited is aiming to do much more than simply give people food. It wants to help people become self sufficient in food, eat healthier food, and preserve the environment in a desert area that experiences intense heat and where water is in short supply. We began our tour in the demonstration garden where people are taught to grow vegetables and keep chickens. The food bank supports some 900 urban gardens and two farms and runs farmers’ markets. Ideally people will grow fresh food that they can eat themselves, have extra that they can sell in the farmers’ markets, and use their food stamps in the farmers’ markets.

We drove (of course) from the food bank to the Las Milpitas de Cottonwood Desert Farm which is supported by the food bank and where people are given a prepared 20 feet by 4 feet plot with irrigation to grow their own food. They are also trained and advised and can buy seeds cheaply from the farmers’ market. The farm was perhaps 150 yards by 40 yards, close to the empty river and the freeway, and under one of the dry mountains covered in cactuses that surround Tucson. The ground is dusty and rock hard, so it’s hard work and needs a lot of compost to prepare a plot. The farmer is a graduate in agriculture from the University of Arizona who is deeply tanned, stick thin, and wearing blue jeans, a checked shirt, and a wide brimmed straw hat: he reminds me of the farmer in that famous American gothic painting by Grant Wood (although when I look at the painting later I see that the famer is not wearing a hat).

From the farm we drive to Manzo Elementary School where the food bank has supported some astonishing work. https://www.facebook.com/Manzo.Ecology?ref=ts The school is 98% Hispanic, and 93% of the children come from families that are below the poverty line. The school is built around two grassy courtyards, and in the corner of one we are shown the home of the desert tortoise. It’s full of flowers, cactuses, and butterflies with a wall of boulders and a boulder home for the tortoise hidden among the flowers. The children built all this, lugging all the boulders from the street outside.

“Do you have two tortoises,” I ask.
“No, it’s illegal to breed desert tortoises,” says Moses, the school counselor who has been the driving force behind all the projects.
“Does the tortoise have name?”
“No, he doesn’t have a name. He’s not a pet. He’s a wild animal who is living among us. We emphasise to the children that he’s not a pet.”

We don’t get to see the tortoise. He’s gone to bed for the night.

In the next courtyard is an area of about five by four yards filled with rich soil and surrounded by a brightly painted wooden fence. The children have that day planted vegetable seeds, pulling up and eating some 300 carrots as they did so. Also in the courtyard are four 10 foot high metal silos to collect rainwater. They are connected by gutters to the roof and are filled by the dramatic, tropical rain that comes to Arizona sometimes. These silos should provide enough water to supply the garden through the hot dry periods.

Also in the courtyard is a chicken coop with six chickens. They too are not given names, and the children understand that once they have produced eggs for two years they will be killed and eaten. These are not the “gentleman farmers” I know from Britain. During the day the chickens roam around the courtyard. Their eggs will be used to make scrambled eggs with the children on the next school day.
But what is the most extraordinary project is saved until last. We enter a once disused schoolroom that contains a circular tank of water about eight feet in diameter and four large containers full of plants—herbs, salads, and cabbage. The water will eventually contain some 60 tilapia, sustainable fish. The waste of the fish is rich in nitrates, and the fishwater is pumped repeatedly through the ceramic balls that fill the containers, soaking the roots of the plants in nutrition they love. The result is that the plants will grow in some 21 days and can be either eaten or sold in the farmers’ market. The whole system should be easily sustainable.

The project is overseen by a retired professor from the university who learnt about this system in Brazil. The water has to be tested everyday, and there is some complicated biochemistry involved. The children are testing the water and learning biochemistry

“You’re teaching 11 year olds biochemistry?” I ask with doubt in my voice.
“We’re teaching 4 year olds,” answers Moses.

I must confess that it made me feel uncomfortable that people in such a rich country are going hungry and have to be fed through charity. A child of the British welfare state, I think that it is the job of the state to abolish hunger—through providing financial benefits. I can see, however, that a food bank that stimulates as much community development as does the Community Food Bank of Southern Arizona brings advantages that the state cannot provide.

RS was the editor of the BMJ until 2004 and is director of the United Health Group’s chronic disease initiative.