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Report: Produce prescriptions, financial incentives help poor eat more fresh fruit and vegetables

Federally-funded programs that encourage low-income people to consume more fresh produce are having a positive impact on diets and the economy, according to an evaluation published on Tuesday.

“These programs work,” said Amy Yaroch, the executive director of the Gretchen Swanson Center for Nutrition, and the head of the GusNIP Nutrition Incentive Program, Technical Assistance, Evaluation and Information Center, which led the evaluation. “There are so many wins across the board.”

The report looks at data from two types of programs: Nutrition incentive programs, which give SNAP recipients more money to spend on fruits and vegetables; and produce prescription projects that prescribe fresh fruits and vegetables to people at risk of food insecurity or chronic disease. All of the programs evaluated were funded by the USDA’s Gus Schumacher Nutrition Incentive Program (GusNIP). The evaluation covered the program’s second year, which ran from Sept. 1, 2020 to Aug. 31, 2021.

People participating in incentive programs — which often match the amount that SNAP recipients spend on produce or subsidize their farm shares — reported consuming more fruit and vegetables than the average American adult, but they still ate less than the recommended amount, the report found. And the longer people took part in these programs, the more produce they ate. While self-reported dietary data is often unreliable, the evaluation used a screening tool that has been assessed for reliability and validity.

The report also found that more than $20.9 million in incentives were distributed in GusNIP’s second year, generating more than $41 million in economic impact.

These findings are important because they push back against stereotypes about poor people’s food choices, Yaroch said. “I do think there’s a bit of this myth that low-income people don’t want healthy foods. And that’s not the case — everyone wants healthy food for their families.”

In Oregon, GusNIP funds were used to expand “double-up farm bucks” programs at grocery stores, especially in underserved communities, said Molly Notarianni, the executive director of the Farmers Market Fund, which coordinated these programs.

“Food insecurity in Oregon has doubled since the start of the pandemic and is currently at the highest level in a century,” she said. “The infusion of GusNIP funds could not have come at a better time, helping families bring home more fresh produce while supporting small farmers and local economies.”

Meanwhile, produce prescriptions showed promising signs of increasing both food security and fruit and vegetable consumption, according to the report. Among the subset of people surveyed before receiving a produce prescription, only 27.5% said they were food secure. But at the end of the program, 49% of respondents said they were food secure. The proportion of people experiencing “very low food security” decreased by nearly half, the report found, while noting that the results should be interpreted with caution, since they came from a small subsample of participants.

While participants in the produce prescription programs reported eating more fruit and vegetables, they still consumed less produce than the general U.S. public, the report found.

Future evaluations will also be able to draw on electronic health records, which will provide data on how prescription programs may be affecting specific health outcomes such as body mass Index and A1C levels, a measure of average blood sugar levels, Yaroch said.

Steven Chen, a physician and chief medical officer of the anti-poverty program ALL IN Alameda County, in California, said his prescription program, Recipe4Health, uses a “food as medicine” model to “treat, prevent, and reverse chronic conditions.” Participants get prescriptions that bring weekly free deliveries of locally and regeneratively grown fruit and vegetables for four months.

In just under two years, the program has prescribed produce to about 1,900 people and distributed around 25,000 bags of food. A smaller number of people take part in weekly group medical visits that cover things like cooking and stress reduction, and also help reduce social isolation.

The ALL IN program includes nutrition education for healthcare providers and trains them to assess food insecurity and refer patients to SNAP. Chen said the approach lets doctors get at the roots of diseases like diabetes, noting that he’s even been able to take patients off of insulin as a result of their participation in the program. “If we’re going to screen people for food insecurity, we’d better have something to offer them,” he said.

Produced with FERN, non-profit reporting on food, agriculture, and environmental health.
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