That’s because for Oliver, 66, food literally is medicine. She receives her box of fruits and vegetables as part of a “farmacy” movement that treats fresh produce as a way to promote health just like a pill or other prescription. She says she eats the fresh ones right away; the flat-tasting tomatoes from the store sometimes just sat and spoiled.
“When we were kids, the farmers in the country brought crops to town and sold it. I had access to fresh farm food. I know the freshness, I know the taste,” she said during a conversation this summer at a social services clinic in a low-income housing project in Charlottesville called Westhaven. The food deliveries, provided by a group called Local Food Hub in partnership with several area health clinics, helped her change her diet, to eat more healthfully. During the pandemic, the program was broadened to help address emergency food needs, but even people who aren’t getting an actual food prescription get the health benefits.
“I’m very conscious of it,” Oliver said. These days, she added, if she feels a bit off, she’s more likely to reach for a healthy bite in the fridge than a bottle in the medicine cabinet.
The idea of “produce prescribing” has been around for several years but it’s been stuck in a niche. Health systems face legal limits and financial disincentives to spend money on carrots and tomatoes; the food system is largely siloed off from the health system. The food-health ventures that have survived often depend on philanthropy and grants.
“These programs haven’t had their moment,” said Michel Nischan, a chef and food advocate who started Wholesome Wave, which promotes and assists produce prescribing, in tandem with local community groups. “They are very difficult to fund.”
One of the upsides of the Covid-19 pandemic, which disrupted the nation’s food supply and at its peak put tens of millions of people out of work, is that lots of organizations intensified their work on hunger, nutrition and food security. And that has driven new interest in increasing access to healthy food, the kind of food that doesn’t just ease hunger but actively promotes health. The kind of food that people need during Covid — and will keep needing after Covid.
An overwhelming share of the people in the U.S who became seriously ill or died from the coronavirus were at heightened risk because they had other health problems related to their diet or food insecurity, including diabetes, obesity, hypertension and heart failure, according to research from the Friedman School of Nutrition Science and Policy at Tufts and data from the Centers for Disease Control and Prevention.
“The pandemic was an accelerant on this conversation,” said Devon Klatell, managing director for food at the Rockefeller Foundation, which is working with some prescribing projects and related researchers. “For health care payers, providers, policymakers — it’s a wake-up call.”
The pandemic made hunger visible — both emergency needs arising from the economic fallout and the unmet structural food insecurity that had been there all along, said Rebecca Onie, a co-founder of The Health Initiative and a pioneer in the movement to weave together health and social needs.
For several years before Covid hit, health care practitioners and policymakers in liberal and conservative states alike had begun looking at so-called social determinants of health, how conditions like homelessness, food insecurity, lack of transportation or domestic violence shaped health status, risk and outcomes. Given that the pandemic also highlighted racial disparities and inequity, those conversations have become more urgent.
Both advocates and researchers are looking at how addressing social drivers could not only improve health outcomes for patients but could also create potential savings to the health care system. A recent Rockefeller Foundation report, for instance, found that poor nutrition and diet alone costs over $1 trillion a year in health costs — $359 billion from obesity and overweight and $604 billion from food-related noncommunicable diseases such as cardiovascular disease, hypertension, cancer and diabetes.
But while those drivers of health, including hunger and nutrition, became part of the conversation, they haven’t really become part of the medical system, apart from scattered pilot programs and state experiments.
That’s what some health groups, advocates and researchers are trying to change now. They want to make food insecurity part of the actual metrics used to evaluate and pay hospitals and physicians in Medicare. Health systems or providers would be held accountable for screening patients for food and nutritional needs – and then addressing them.
Gary Price, a Connecticut surgeon who is president of The Physicians Foundation, which formally submitted the proposed metric, noted that existing quality programs can penalize doctors financially if their patients do poorly under some rubrics. But doctors don’t have a lot of control, for instance, when patients with diabetes can’t afford fruits and vegetables, filling up instead on processed food that may be cheap but isn’t good for them.
“There are problems a prescription for medication simply won’t solve,” Price said. Giving doctors tools to address social factors — and holding them accountable for doing so — is overdue.
It’s a long, multi-step regulatory road — and there’s a parallel process with Medicaid. There’s no guarantee that it will turn out the way the advocates want; many other metrics are already in use, or under consideration, and they haven’t centered on poverty and health.
