How Prescribing Local, Sustainable Produce Can Tackle Food Insecurity

Photograph courtesy of Brian Frank

Dr. Brian Frank practices family medicine at Oregon Health and Science University in Portland, Oregon and is a big proponent of introducing the importance of local, sustainable and healthy food to his patients. He is part of a new but growing movement in health care that helps food insecure patients access healthy, locally-grown produce through community supported agriculture, vouchers for farmers' markets and "food pharmacies" at hospitals. Such forward-thinking strategies benefit both patients and local economies. Read more in our interview with Dr. Frank about the value of "prescribing" healthy and local produce, what it might take to make this a national movement and how his work is driven by the magic that food and cooking can bring to families.

How can health care address sustainable food production, food insecurity and nutrition at the same time?

At a cost of $3 trillion annually, the United States health care system is one of our country's largest industries. Over five percent of that figure is spent treating the downstream costs of food insecurity, and more to treat the effects of poor nutrition. We need to start investing health care dollars in projects that improve access to fresh, sustainably-grown produce. Imagine if the health care system put a tiny fraction of its budget into subsidizing the growth and distribution of healthy produce to low-income families. It would support local economies and improve community food security. Couple that with nutrition education classes and the return on investment is obvious.

Tell us about how you "prescribe" fresh produce, and your work to incorporate CSAs and farmers' markets with family medicine. How has it benefitted your patients? 

Nearly seventy-five percent of adults qualifying for Oregon's Medicaid programs are food insecure. That's higher than the rates of diabetes, depression and ischemic heart disease combined, and an independent risk factor for each. Thankfully, there are efforts underway across the state to improve access to fresh, healthy, locally-grown produce.

The hospital where I did my residency (Providence Milwaukie) has a "food pharmacy" where providers can "prescribe" an emergency food box to families who screen positive for food insecurity. An entire hospital system in the Columbia Gorge is supporting Gorge Grown, a nonprofit organization in the Columbia Gorge, which distributes vouchers through primary care clinics that are redeemable for local produce sold at farmers' markets and local grocers. Physicians in these clinics are literally prescribing fresh veggies.

Our clinic, OHSU Family Medicine at Richmond, is entering its second year of providing subsidized CSAs to food insecure patients as part of a partnership with Zenger Farm, Multnomah County Health Department and Portland State University. We've found that patients increase their fruit and vegetable intake, decrease their consumption of junk food and sugar-sweetened beverages and enjoy an increased sense of community cohesion from showing up each week to pick up their shares.

Sustainable, healthy food can be out of reach for low-income communities for many reasons including cost and access. What are ways that can help bridge that divide?

The American Heart Association recently published a report showing that a 10 percent reduction in the cost of fresh produce could prevent about 150,000 deaths. If we apply that figure to our CSA model, we'd need to spend about two dollars per person for a whole month. That's about the same as a bottle of aspirin. As far as access, there are people much smarter than I working on decreasing the burden of "food deserts." Incorporating farmers' markets or CSA pickup sites in community health clinics would certainly be a great way of increasing access.

What would it take to turn similar CSA and fruit and vegetable prescription programs into a national movement?

There are two major needs: first, there needs to be buy-in from a health care entity.  This could be a public or private insurer, or simply a hospital system that's willing to demonstrate innovative leadership by investing in one of these programs on a scale large enough to show demonstrable change through a well-designed research study. Second, the data from such a study should to be used to create an economic model that clearly demonstrates the significant return on investment that I'm confident will occur.

How else can health care play a role in moving our food system in a more sustainable direction?

Invest, demonstrate, educate. Invest: Put the weight of our multi-trillion dollar industry behind a sustainable food system by investing in local farms to produce crops that can feed communities, especially those in need.

Demonstrate: Get rid of snack and soda vending machines in hospitals and clinics. Replace them with fruit and vegetable mini-markets. Change hospital menus so that the burger n' fries station isn't front and center in the cafeteria.  Showcase local produce and healthy food options. Put recipe cards next to the food line that show the importance and ease of eating healthfully.

Educate: Put teaching kitchens in waiting rooms and hospital wards. Nothing fancy, just an induction burner and some cutlery. Have regular demos for patients and families that highlight seasonal produce and other healthful ingredients. Make nutrition education a central part of disease prevention and management for all patients. In short, we need to be the ones to change the conversation.

Is your interest in the food system something that evolved after you began practicing medicine, or is it something you've always been thinking about?

When I was eight years old, my mother decided to change careers. She continued to work full-time as a high school English teacher while going to law school at night. My dad became the de-facto meal provider. He always let my brother and me help choose the menus for the week and, as we got older, gave us jobs in the kitchen helping prepare meals. As a result, family time was solidly bonded to food. To this day, cooking is, to me, a demonstration of love. In my clinical practice, I care for families who can't always afford to put meals on the table. It's more than just a lack of food, though, it's a deprivation of security and a painful, often shameful, loss for parents. Imagine not being able to say, "I love you" to your children. Knowing how magical food and cooking can be to a family unit, and then watching the trauma that occurs when that magic is just out of reach is a driving force for the work I do.

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