Title: Food as Medicine in Washington DC
Expanding access to healthy, affordable food for low-income residents who suffer from high rates of diet-related chronic diseases
Country: United States
Date of start: 01/2013
SDGs: 2, 3, 10.
Twitter: @produceplusdc @DCFoodPolicy @_DCHealth
Instagram: DC Greens
Since 2013 Washington DC has invested in several innovative programmes recognizing the crucial role that diet places in overall health. These “food as medicine” programmes, including Produce Plus and Produce Prescription (Rx), aim to increase access to healthy food and address the significant disparities in diet-related chronic illnesses among District residents.
While there is one grocery store for every 8,000 residents in some wealthier Wards (neighbourhoods) in the District, there is only one grocery store for the 85,200 residents in Ward 8, the lowest-income Ward. Low-income residents living in this area experience nearly six times the rates of diet-related chronic disease than residents in wealthier neighbourhoods. As the District considers strategies to attract more grocery retailers to low-income neighbourhoods, it recognizes the critical need to make healthy food more accessible now to residents in these areas.
Produce Plus offers residents participating in qualifying government assistance programmes, including state-sponsored health insurance, $10 twice a week to purchase fresh produce at local farmers markets. Produce Rx works with healthcare providers to prescribe food-insecure patients at-risk of or experiencing diet-related chronic illnesses with $20 prescriptions for fresh produce each week that can be used at farmers markets and, through a recent expansion, the Ward 8 grocery store.
For its commitment to provide subsidies to residents participating in the local government health programs, for fresh fruit purchase in local markets. Its initiative developed educational and volunteering activities and mobilized an impressive number of people. It reached over 9.500 persons, mainly low income residents, and catalyzed cross sector public-private partnership.Motivation of the MPA 2019 Evaluation Committee
The department of health (DC Health) funds Produce Plus and Produce Rx and DC Greens administers the programmes. Healthcare organizations inform patients about the programmes and provide additional funding to study program impact. Farmers markets work with DC Greens to distribute the Produce Plus vouchers. Lastly, the DC Food Policy Council, appointed by the Mayor, convenes District agency partners and community organizations to develop strategies to strengthen existing programmes.
Although a growing body of research links diet to overall health, many local governments in the United States have not yet explicitly invested in food-as-medicine programmes. The District’s investment in these programmes makes it a leader among U.S. cities, especially because these programmes do not require a dollar match from participating residents. The District’s investment in Produce Plus has grown from an initial investment of $50,000 in 2012 to more than $1.1 million in 2018.
The transformative power of Produce Plus comes from its community-centred design. In addition to the Market Champions, who are paid to promote the program in their communities, Produce Plus draws a significant volume of volunteers from the communities served by the program. In turn, Produce Plus helps increase the purchasing power of low-income residents and provides additional income for local farmers in the region.
The District’s investment in Produce Rx also makes it a national leader in investing in food-as-medicine programmes. In 2018-2019, the District funded an expansion of Produce Rx that allows participants to spend their vouchers at the grocery store in Ward 8. This pilot is a collaboration between DC Health, the healthcare provider AmeriHealth, DC Greens, and Giant Foods. The patients connect with an in-store nutritionist at the grocery store who advises them on how to make healthy purchases with their vouchers, better equipping them with the knowledge to make healthier purchasing decisions.
The District’s food-as-medicine programmes impact participation, healthy behaviours and local food investment. In 2018, Produce Plus provided over 9,000 participants with bi-weekly coupons, totalling nearly $877,200 distributed with an impressive 95% redemption rate. More than half of the residents who participate in Produce Plus live in the two wards of the city with the fewest grocery stores. While Produce Rx is smaller, the program provided weekly vouchers to over 112 patients through five clinical partners in 2017. With the rollout of the 2018-2019 pilot, the program will impact more than 500 residents this year, a nearly four-fold increase.
The programmes also improve healthy behaviours among participants. A 2015 analysis found that Produce Plus participants consumed more fruits and vegetables than residents with similar incomes who did not participate in the program. A 2017 evaluation of Produce Rx showed an even more significant impact on its participants – more than half of the Produce Rx participants reduced their BMI, 90% improved the relationship with their doctor and 64% increased their produce intake.
Finally, the programmes support local farmers and increase the viability of local farmers markets. Participants in Produce Plus and Produce Rx directly pay farmers for their produce, providing an important income stream for small farmers, many of whom are low-income themselves. The program is estimated to generate approximately $16,000-20,000 per participating market.
The District’s food-as-medicine programmes catalyse cross-sector partnerships between local government, community organizations and healthcare providers. DC Health collaborates with other District Departments such as the Department of Human Services, which administers federal nutrition assistance programmes, and the Department of Healthcare Finance, which administers federal healthcare programmes. Community organizations like DC Greens implement and expand the reach of the programmes to vulnerable populations like low-income residents, seniors and residents with disabilities. These community partners also provide opportunities for residents to get engaged by spreading the word to their neighbours. Healthcare providers refer eligible patients to the programmes and ensure patients understand how diet impacts health. Local farmers markets help implement the programmes at their markets.
In addition, the District’s food-as-medicine programmes are targeted to low-income residents experiencing food insecurity or a lack of healthy food access. By ensuring that these low-income residents can afford and access the same fresh, healthy food that wealthier residents buy, the District and its partners signal their commitment to inclusion and equity for all residents.