It was Hippocrates who long ago declared, “Let medicine be thy food and let food be thy medicine.” Today, the idea of food as medicine is the foundation of health initiatives being developed collaboratively by hospitals, health organizations, local health departments, food banks, and farms across the country.
Access to healthy food and knowledge of how to prepare it has perhaps never been so urgent as today, when half of Americans are estimated to have some type of chronic disease stemming from such risks as unhealthy eating, lack of exercise, obesity, and smoking, according to the Centers for Disease Control and Prevention. Treatment for these illnesses, which include asthma, heart disease, and diabetes, has been estimated to account for more than 75 percent of hospital admissions and physician visits in recent years.
Innovative programs are providing increased access to free or low-cost healthy food, as well as nutrition and cooking know-how for low-income people with health risks. They typically have a research component to track health outcomes of participants.
In 2011, staff at the Philadelphia-area Lankenau Medical Center (part of Main Line Health) looked at evidence that it was serving the unhealthiest county in Pennsylvania and began a food-as-medicine initiative that started with the construction of a half-acre organic farm on its campus to provide fresh produce to patients.
The hospital teamed up with a local Philadelphia nonprofit, Greener Partners, to build and maintain Deaver Wellness Farm, which, since 2015, has provided more than 4,000 pounds of organic produce to patients at no charge and has also supplied food for the hospital cafeteria as well as nutrition education classes and demonstrations. Students come to the farm for hands-on opportunities to learn about nutrition, gardening, and health.
Lankenau is not the nation’s only hospital-affiliated farm. Others include St. Joseph Mercy Ann Arbor and Henry Ford West Bloomfield Hospital, both in Michigan, and St. Luke’s University Health Network in Pennsylvania.
New Haven Farms Starts a Wellness Program
In New Haven, Connecticut, New Haven Farms has transformed eight vacant city lots in poor neighborhoods into small organic farms since 2012. The farm sites, owned by the city of New Haven, Chabaso Bakery, and Phoenix Press, not only grow food for a CSA, but also partner with two federally qualified health centers that care for the city’s most medically underserved residents, the majority of whom suffer from diet-related chronic disease risks and economic hardship.
In the Farm-Based Wellness Program, medical providers from the Fair Haven Community Health Center and Cornell Scott–Hill Health Center refer adult patients who have at least two diet-related chronic disease risk factors and who live within 200 percent of the 2010 federal poverty level. During the summer growing season, patients and members of their families come to the farm for weekly bilingual Spanish/English cooking demonstrations, nutrition classes, and gardening seminars. They also take home a share of fresh vegetables and fruits every week, along with culturally relevant, affordable, nutritious, and bilingual recipes.
Click here to watch a video about New Haven Farm’s Farm-Based Wellness Program and here to see one woman’s journey toward better health, thanks to the farm’s program.
Doctors Write Prescriptions for CSA Shares
In Portland, Oregon, CSA Partnerships for Health has created partnerships linking four Multnomah County Health Department clinics and one neighborhood clinic of Oregon Health and Science University (OHSU) with vegetable farmers who have a community-supported agriculture (CSA) program. Partner farms bring healthy, local, seasonal vegetables every week for 20 to 23 weeks to patients at these health clinics at a discounted cost made possible by Kaiser Permanente’s Healthy Eating Active Living (HEAL) program and the Oregon Department of Agriculture.
The Partnerships program grew out of a 2015 pilot program known as the Prescription CSA Program, in which doctors “prescribed” weekly produce boxes for families with nutrition-related illnesses like diabetes. The health clinics also offered cooking demonstrations and workshops. The current program, to be evaluated over three years, is designed to improve family health while also driving more healthcare spending into local agriculture.
Project partners include Zenger Farm (a farm featured in our own Bounty From the Box: The CSA Farm Cookbook) and several other local CSA farms, as well as the Multnomah County Health Department, Oregon Health and Science University’s Family Medicine at Richmond, Kaiser Permanente’s HEAL, the Oregon Department of Agriculture, Providence Health and Services, Portland State University, Wholesome Wave, Village Gardens, Oregon Food Bank, and Adelante Mujeres. Pilot program participants reported losing weight and liking vegetables more than before, while healthcare practitioners at participating clinics said they were glad to have a new option to help patients with chronic diet-related diseases, and appreciated being able to refer patients to a food-based program instead of having to just write another medication prescription.
Food banks are also trying food-as-medicine approaches for improving the health of the people they serve. Feeding America, a national network of food banks, began a trial program several years ago in response to the dramatic increase in diabetes, especially type 2, which disproportionately affects low-income people living with food insecurity. Between February 2012 and March 2014, member food banks in three urban areas in Ohio, California, and Texas provided diabetic clients with appropriate food, education, blood sugar monitoring, and referrals to primary care physicians. Results included significant improvement in diabetes control, medication adherence, and overall improvement in healthy diets. A second phase of the trial will conclude in December 2017.
Wholesome Wave Makes Fresh and Local Produce More Accessible
Perhaps the largest food-as-medicine program in the country is the Fruit and Vegetable Prescription Program (FVRx), started in 2010 by Wholesome Wave, a national nonprofit that connects low-income people with local produce. The organization was founded by chef Michel Nischan, who was motivated to make healthful food more accessible after his two sons were diagnosed with juvenile diabetes. With funding from state and federal agencies and private foundations, the organization works in urban and rural areas that are medically underserved or are considered food deserts.
When a patient receives an FVRx prescription, it’s typically accompanied by nutrition education from a provider, nutritionist, or dietician. Patients redeem vouchers for fruits and vegetables at local food retailers and farmers markets. Over 2,200 patients and their families have received such prescriptions in 12 states. Discount store retailer Target has sponsored the largest FVRx program to date, in which more than 500 families who receive healthcare services at the Eisner Pediatric and Family Medical Center in Los Angeles are now receiving produce prescriptions from their doctor, along with vouchers to purchase fresh produce at Target stores and nearby farmers markets. The majority of families enrolled are already receiving SNAP benefits, which the FVRx program increases by an amount that must be spent be spent exclusively on fresh produce.
If you’re curious to learn more about the food-as-medicine approach for yourself, you might want to look for a new cookbook with this focus, Food as Medicine Everyday: Reclaim Your Health with Whole Foods. Published in 2016 by National University of Natural Medicine Press, it was written by NUNM faculty members Julie Briley, ND, and Courtney Jackson, ND.
About the author: This week’s blog post and pictures come from Martha Wagner, a Portland, Oregon-based food writer, gardener, and passionate advocate for sustainable living, wellness, and organic agriculture.
Picture credits, from top to bottom: All pictures courtesy of New Haven Farms except for Deaver Wellness Farm, courtesy of Lankenau Medical Center, and bottom picture, by udra11, Adobe Stock.
A thoughtful, insightful and timely summary of a powerful movement to transform access to and consumption of healthy foods across the spectrum of our country’s demographics. Deeply appreciate this summary and rich reference for all of us in the health domain. Thank you. Martín Sepúlveda MD IBM Fellow
Thank you so much for your thoughtful comments, Martín, and your support of both better food and health systems. The connection between diet and chronic disease, while it’s been obvious for quite some time, is only beginning to be validated by mainstream healthcare in terms of proactive, effective, truly behavior-changing programs. I really appreciate your role in helping to foster this whole-systems thinking in your medical work. Thanks again. —Mi Ae