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An Apple a Day: Doctors and Organizations Writing a New Nutrition Rx

Can an apple a day really keep the doctor away? As it turns out, there’s more truth than myth to this sage saying. Not only are apples a low calorie food with tons of vitamin C, they also contain phytonutrients, which prevents neurodegenerative diseases like Alzheimer’s and Parkinsonism. Though the wonders of apples as preventative health may not be common knowledge, we can all get behind the idea that everyone needs to eat more fresh fruit and vegetables to live a healthy, long life that involves fewer doctor visits. Doctors and farmers both think so, and they’re teaming up to help make this a reality.

Nonprofits, like Wholesome Wave and DC Greens, which runs several food access and urban agriculture projects in our nation’s capital, are connecting physicians who are already dedicated to preventative wellness and nutrition, like those at Unity Health Clinic (Unity) in Washington, D.C., to fresh produce.

Physicians and physician assistants (PAs), like PA Jessica Wallace at Unity, are writing prescriptions for locally grown fruits and vegetables that their low-income patients can then take to five D.C. farmers’ markets, Columbia Heights Community Marketplace, Mount Pleasant, 14th and U St., Bloomingdale, and Glover Park-Burleith.

“We know nationwide that poor minority communities suffer disproportionately from chronic effects of nutrition and obesity,” says Wallace. “We’re able to target these people through partnerships to have a big impact for the people that need it the most.

Last year, Wholesome Wave partnered with 12 clinics and nonprofits around the country to run the Fruit and Vegetable Prescription Program (FVRx). Farmers’ markets have now become pharmacies, recommending berries for weight loss, leafy greens for heart health, and apples for neurodegenerative disease prevention. Physicians, in turn, are tracking body mass index (BMI), blood pressure, and work with community health workers and nutritionists to regularly check in with patients to see if they’ve improved their nutrition and increased their amount of physical activity.

“It’s awesome from a community health perspective,” explains  Wallace. “Targeting kids who are obese and overweight, but not stopping there. FVRx actually supports the entire family; once the kid qualifies for the program the entire family will receive the benefits, even though we were only monitoring the data of those qualifying kids.”

The connections between preventative healthcare and providing farmers with a more robust marketplace are being made at farmers’ markets. This budding relationship between doctors and farmers is even more important than ever before. At a time when we have more small farmers reliant upon farmers’ markets for a large part of their income and more overweight Americans with a lack of access to healthy foods, FVRx is convening multiple players to engage in hard conversations.

According to the Bipartisan Policy Center, obesity is the single largest threat to public health in America today. More than one-third of U.S. adults are obese, another one-third is overweight, and these rates keep on rising. America spends an estimated $190 billion annually on obesity-related illnesses. And while some of these costs are borne by the private sector, obesity also places a growing financial burden on the public. If we consider how much we spend on obesity related care, community-based wellness programs that target obesity with nutrition, fitness, and education could prove to be a cheaper solution.

Over 12 percent of D.C. households reported difficulty in affording and accessing fresh fruits and vegetables. At Unity, each family received $7 per family member, per week–a family of four received $112 every month for about 24 weeks. These extra dollars brought struggling families to the farmers markets and enabled them to purchase more fresh fruit and vegetables.

“D.C. is a city of dichotomies,” says  Wallace. “There’s a tremendous wealth and opportunity here with constant changing demographics, but a lot of people living in D.C. struggle and don’t feel empowered in their surroundings.”

Columbia Heights Community Marketplace (CHCM), the most proximal farmers market to Unity, redeemed about 75 percent of FVRx prescriptions last year, bringing in about $600 per week and directing these extra dollars to six produce farmers. Josh Levine, the Market Manager at CHCM, says that the FVRx program was incredibly well received during their pilot season. He says, “It’s an interesting new program that gets people talking about food access in our community.” Matt Hirsch, a farmer vending at CHCM, says, “It has increased our sales and correspondingly our income.”

Hirsch describes the program as a way to connect to customers that he didn’t have relationships with before: “I’ve been able to talk to FVRx customers about what they planned to do with the things they bought and why they were buying them. Many of our FRVx customers tend to buy a lot of produce.”

The FVRx program enables low-income patients, like those at Unity, to take their health to another level. “They are incentivized and invested in a different way,” says Wallace. “Last year these patients had a tangible opportunity to take the information they were receiving from nutrition classes and actually apply it in a way that they wouldn’t have been able to do without this support.”

Increasing one’s intake of fruits and vegetables may seem like an unnecessary investment when compared against today’s looming economic pressures, but it has a potential for big returns. Out of the 36 children who participated in FVRx at Unity last year, 53 percent saw a decrease in their BMI percentile, a measurement that qualifies them for being obese and overweight.

This implies that in addition to enjoying the farmers’ market experience and developing good eating habits at a young age, FVRx was successful in reducing the rate of obesity for these at risk youth. These kinds of partnerships are making the case; that yes, nutrition education coupled with physical activity and an increased intake of fresh fruits and vegetables will reduce one’s chances of being obese, and at a more affordable price than our mainstream healthcare system.

The FVRx program is outstanding, because doctors have their patients’ trust and are viewed as authorities, so when they say that “you need to eat more fresh fruits and vegetables and here’s where you can get them, oh, and here’s some extra market dollars you can use to purchase them,” then you take heed. There’s research to be explored on this topic as we move past the pilot years. Doctor-patient relationships built around increasing healthy food access at farmers markets could make a strong case as to how and why we need to change our healthcare and food systems.

The Farmers Market Coalition reminds us that farmers’ markets are more than transactions for food. They are rooted in community and can play a significant role in improving our overall health. Ashley Fitch, Wholesome Waves’ FVRx Program Director, describes FVRx as community driven.

Fitch says, “There has been a good deal of interest expressed from clinics and healthcare professionals in joining the Wholesome Wave FVRx umbrella.” As we move into 2013, Wholesome Wave will be focusing on the sustainability of FVRx, which means paring down the number of partner organizations they work with in the near future.

“Wholesome Wave is thinking more carefully about the nutrition education standards as we move forward,” says Fitch. “We’re going to be focusing on gathering data for proof of concept, identifying key policy targets, scaling the program, and engaging an advisory board to help guide a panel of experts in the field.”

Unity sees 90,000 underserved D.C. residents at several sites throughout the city. Wallace would like to have the Unity clinic in Upper Cardoza be an example of what can happen at all Unity clinics in the city. Lauren Shweder Biel, the Executive Director of DC Greens, would agree that there’s a lot of potential to pilot programs like FVRx throughout the city.

FVRx was a program birthed from innovation, a need, and existing relationships. “We want to look at other systems were DC Greens has strong partnerships,” says Biel. “DC Greens has extensive relationships with District schools and we are thinking through what other food access projects would be like with other similar institutions concerned about community health and wellness.”

Additionally, Physicians are rethinking the role nutrition plays in the healthcare system, but the funding has to catch up to their ambition. Philanthropic fundraising for these projects can only go so far. D.C., in particular, has a tax surplus that policymakers are considering putting towards healthy food access projects. Hospitals in the District with bigger wallets are also beginning to think about whether this program is worth their while.

The only way these programs will ever be truly sustainable is through public-private partnerships; where cities plan for them in their budgets, private investors, and corporations have continued commitment, and hospitals build them into their financial structures.

Whether we find support for FVRx through building community wellness into our institutional and city financial plans, or through further examination of the success of FVRx as being fiscally responsible and clinically proven, those that are dedicated to our community’s healthcare and wellbeing, particularly in D.C., are stepping up to the plate.

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