Justice at the dinner table

Justice has been a big topic of conversation here at APHA’s 2019 Annual Meeting and Expo in Philadelphia, and a session today zeroed in on ways to use prescriptions for fresh produce to improve food justice.

That means giving people living in food deserts not just easier access to fresh fruits and vegetables but also understanding why that alone isn’t enough.

Presenters at the session — “Take Your Medicine: Fruit and Vegetable Prescription Programs and Their Influence on Health” — shared both small successes and lessons learned. Research has shown such prescriptions can improve people’s healthy eating habits, but there’s still a lot of unknown territory when it comes to how to translate that progress into better health.

Angela Talhami, manager of the Produce Rx program at DC Greens in Washington, D.C., said health providers are asking for input on improving nutrition. That’s because food insecurity is directly linked to chronic illnesses like diabetes and high blood pressure.

“They need tools to help their patients take care of their health,” she told a packed audience at the Tuesday afternoon session.

The program, which from 2012-2017 used a local farmers market as an avenue for improving access to fresh produce, found an up to 55% drop in body mass index among participants.

“That was a huge and very important number when you’re thinking about (emergency room) diversion,” Talhami said.

The program is now operating under a new “grocery-store model.” For example, a Giant grocery store in D.C.’s Ward 8 is participating in the program and has hired a full-time nutritionist to offer one-on-one advice to participants. Doctors send produce prescriptions directly to the store’s pharmacy, and participants pick up a coupon there to use on fruits and vegetables at the store.

Each prescription is good for three months, then participants have to go back to their doctor for a check-up and new prescription. The goal is to enroll 500 people by the end of February and gather results in April.

“The goal is really to be able to expand to all of D.C.,” she said.

Nicole Fournakis, a research associate in the Office of Health Equity for ChristinaCare, one of the largest health care providers in the Mid-Atlantic, shared results of a program that was designed to improve the diets of pregnant and postpartum women in a low-income area of Wilmington, Delaware. Participants were offered up to 12 vouchers, each worth $25 in produce from a local stand. Yet, of the 173 women who participated, 116 did not pick up a single voucher. 

Why? Barriers included a lack of transportation and the fact that the produce stand was only open 9 a.m.-5 p.m. on weekdays. So in a revamped version of the project, community health workers began providing nutrition education and also calling women to remind them about the availability of local fresh produce.

In 2018, Congress authorized $4 million to fund pilot prescription produce programs from 2019 to 2023, so there’s a lot of interest in what works and what doesn’t. Kudos to researchers like Fournakis and community-based advocates like Talhami for working so hard to fine-tune such key nutrition outreach.

Learn more about prescription produce programs from the U.S. Department of Agriculture and wholesomewave.org.