When Katie Molitor joined the Columbia Center for Urban Agriculture in 2019, she knew Boone County needed to put nutritious, affordable food on more tables.
Two years later, she came up with a plan: Give year-long prescriptions to patients for fresh fruits and vegetables to supplement their diet. The idea took root, and the result is Produce Prescription, which makes fresh produce available with a prescription.
Compass Health writes the prescriptions for families with children under 19 to exchange for produce tokens at the Columbia Farmers Market. The vouchers can be redeemed at any of the market vendors.
Since 2021, the program has distributed around $118,000 in fresh produce, with families getting up to $20 each to spend every week.
“This seems to be a really effective type of public health intervention to help people with chronic diseases and people who are food insecure,” Molitor said.
[subhed]The bigger picture
[/subhed]
The United States is mired in a health and hunger crisis, including in the Midwest. Food insecurity is defined by the U.S. Department of Agriculture as the lack of consistent access to enough food to live an active, healthy life.
As of 2021, at least 20,000 Boone County residents were considered food insecure, according to Feeding America.
Food insecurity has cascading effects, not only for health, but for wallets. To cope with the inaccessibility of wholesome foods in recent years, 61% of households purchased the least expensive food available, even if it wasn’t the healthiest option, according to the Food Assistance and Hunger in the Heartland 2021 report.
The reality is that nutritious food can be hard to come by and unaffordable for many people.
On a larger economic scale, an estimated 90% of the $4.3 trillion annual cost of health care in the U.S. is spent on medical care for chronic diseases, according to the American Heart Association.
One nationwide intervention to address the consequences of poor nutrition is the Food is Medicine movement. With initiatives backed by the Rockefeller Foundation, the American Heart Association, Kroger and more, the campaign does not have a single definition.
Rather, it is underscored by the shared sentiment that the effects of diet-related diseases can be mitigated by health interventions.
Such efforts include the promotion of food safety and education, offering produce vouchers to people facing diet-related diseases or food insecurity and issuing prescriptions for nutrient-rich food, much like the program in Boone County.
“At Columbia Center for Urban Agriculture, we’re all about Food is Medicine,” Molitor said. “We’ve had people tell us that they’re off insulin now, they’ve lost weight, their cholesterol has decreased.”
A look at legislation
Last fall, the Biden-Harris administration got on board, announcing its support for legislation that would extend Food is Medicine interventions to some Medicare recipients, as well as those on Medicaid.
In a call to action, the administration urged states to “leverage all available federal authorities to expand coverage of ‘food is medicine’ interventions,” according to the administration’s September 2022 National Strategy on Hunger, Nutrition, and Health report.
According to the report, a Section 1115 waiver under the Social Security Act would permit Medicaid to officially implement pilot programs to cover the costs of nutrition interventions for patients.
While MO HealthNet, the state’s branch of Medicaid, has active Section 1115 waivers for postpartum women and children in foster care, it has no waiver for nutrition interventions. If Missouri does apply, the waiver would be in effect for five years, with renewals up to three years.
In the absence of a Section 1115 waiver, organizations like the Center for Urban Agriculture, the Farmers Market and The Food Bank for Central & Northeast Missouri continue to be the backbone of support for the Columbia area.
The Food Bank’s mission
Alma Hopkins, registered dietitian for the Food Bank, is acutely aware of the link between food insecurity and chronic disease. For every 10 people the bank serves, she said, four to six are living with chronic, diet-related diseases.
Since she joined the Food Bank team, Hopkins has addressed Boone County’s diet deficiencies through classes on how to use, store and benefit from fresh produce.
By doing so, her program has joined the growing list of Missouri initiatives dedicated to fostering health equity through nourishing meals. By partnering with agencies and serving mobile food pantries, The Food Bank for Central & Northeast Missouri served individuals and families through mobile food pantry distribution 118,000 times in 2022.
While the bank has offered fresh produce for years, its director of communication, Katie Adkins, said it is still progressing from the canned goods food-banking model.
“In general, the food bank is moving toward a fresh, healthy distribution,” Adkins said. “Right now, about 64% of what we share is what we call ‘foods to encourage.’”
The gold standard includes fresh produce, dairy, lean protein and canned and frozen fruits and vegetables. Hopkins also advocated for whole foods, placing an emphasis on the healing power of vegetables, fruits and legumes.
“It’s really inundated, the amount of testimony that’s out there that says food is medicine,” Hopkins said. “For example, green leafy vegetables, spinach, kale. They’re wonderful resources. They help slow macular degeneration, which is an aging process of losing sight.”
In addition to adding cooking classes with her new Teaching Kitchen, Hopkins’ duties historically include offering food tastings, providing food safety materials and crafting health-conscious recipes for the public. In her words, the goal is simply “to grow appetites for the food that keeps people happy and healthy.”
While a holistic approach to treating disease is not new, little research has been done on a consistent or large enough scale, however, to quantify the healing potential of food.
Meanwhile at the market
In addition to the Produce Prescription program, the Columbia Farmers Market has two programs that help those receiving food assistance, both designed to get fruits and vegetables from vendors’ gardens to consumers’ kitchens.
The Access to Healthy Food Program caters to recipients of the Supplemental Nutrition Assistance Program or Women, Infants and Children program who are Boone County residents and are either seniors, have a disability or have children 19 or under living at home.
To receive matching benefits, recipients can swipe their EBT card for any amount or provide a cash match and receive up to $35 in tokens. These tokens can then be redeemed on eligible items at the market’s approximately 60 vendors.
“The Access to Healthy Food Program has grown this year with the voucher recipients coming in,” said Jon Weekley, assistant manager of the farmers market. “At our peak season, we had about 100 to 120 transactions on a given Saturday.”
The other program, Double Up Food Bucks, is a federally-funded initiative that matches up to $25 for SNAP recipients.
For people like Indiana Garcia, the program’s small, green tokens were her ticket to bringing a little bit of home and health into her new kitchen.
In pursuit of her master’s degree, Garcia left Nicaragua in 2020. By her side were her husband and two children, ages 6 and 15 at the time. For her children, the first six months of their residency were marred by uncertainty around all things food. While they were accustomed to Nicaraguan produce, the family was unfamiliar with the fruits and vegetables available in the Midwest.
“When we came here, we didn’t know how to navigate the new customs, the new foods,” Garcia said. “So, you don’t want to spend money on things you don’t know if you’re gonna like or not, right?”
That’s when the Columbia Farmers Market came in. Using the Double Up Food Bucks program, Garcia’s family is able to use SNAP benefits to help maintain the lifestyle they want and try new foods with no economic burden.
Garcia’s son, Luis Guevara, now 18, said he has grown fond of experimenting in the kitchen. Among the family’s favorites is his pumpkin bread, made with ingredients picked up at the market.
“I made everything from scratch. I bought a pumpkin and made it into a puree,” Guevara said. “That was the time the house was at its messiest, but that bread was amazing.”
Garcia said having access to whole foods on a tight budget has given her children the ability to grow comfortable with eating new things.
“He would start baking and do cakes,” Garcia said. “And they were like, ‘Oh, they’re familiar. They’re very tasty. They’re good.’ And it was nice because then I was like, ‘Finally we’re eating healthy.’ We’re eating what is found locally, and at the same time, we are on a sharp budget.”
Garcia said she would like to use the program for as long as possible until she is in a position to pay it forward.
“It gives you that moral obligation once you are good,” Garcia said. “This is a program I need to look back at and also put some of my money in it. Because it did help me, and it can help others.”
This story originally appeared in the Columbia Missourian. It can be republished in print or online.
