By Lynn Graebner, California Health Report | August 12, 2016

As health care providers struggle to reduce the tsunami of diet-related disease washing over communities, a national movement is pairing hospitals and community clinics with local farmers markets through fresh produce prescription programs.

Participants in the programs are patients with health issues such as heart problems or diabetes who receive vouchers for fresh local produce sold at farmers markets located at or near their hospital or clinic.

“When we address access and affordability, diets change overnight,” said Gabrielle Langholtz, communications manager for Wholesome Wave, a national nonprofit working to make fresh produce more accessible and affordable for low income populations.

In 2010 the organization launched its first two Fruit and Vegetable Prescription (FVRx) Programs in affiliation with health care centers in Maine and Massachusetts. Wholesome Wave estimates that there are now more than 60 similar programs in 10 states.

Troy Fink of Prunedale was one of the first participants in Salinas Valley Memorial Hospital’s Fresh Produce Prescription Program, formed in partnership with Marina-based Everyone’s Harvest, which runs five certified farmers markets in Monterey County.

Fink had joined the hospital’s diabetes class after being diagnosed with full blown diabetes. He was placed on a vegetable-based whole-foods diet. So when the first full year of the produce program started in 2015, “it was a no brainer,” he said.

On his new diet, with no meat or dairy, every meal had to change drastically. His wife, Nicole, got on board as well.

“We found substitutes for everything. There’s some really tasty stuff out there, I just didn’t know,” Fink said. He traded in pizza and pot roast for cucumber sandwiches with hummus on rye and oatmeal with fresh fruit and nuts. He’s lost more than 50 pounds, his cholesterol levels are in the normal range and he has been off all his medications for more than six months.

Wholesome Wave’s work inspired Everyone’s Harvest to partner with Salinas Valley Memorial Hospital to form the Fresh Produce Prescription (Fresh Rx) Program in 2014 with a pilot of five patients.

It was so successful that the hospital wrote a grant proposal and got funding to increase it in 2015 to 32 participants. Medical staff provided nutritional education and recorded patients’ weight, body mass index, waist circumference and blood pressure. After 23 weeks 31 participants had completed the program and they collectively lost 159 pounds, 75 inches around the waist and took 27 points off their body mass index, a measurement of body fat based on height and weight.

Last year Seaside Family Health Center joined the program and this year Natividad Medical Center came on board. In 2016 Everyone’s Harvest farmers markets will serve 110 patients through the program, 75 from Salinas Valley Memorial, 14 from the Seaside clinic and 21 from Natividad, said Reid Norris, interim executive director for Everyone’s Harvest.

Weekly seasonal markets will be on site at the two hospitals and Seaside Clinic patients can shop at the year-round weekly markets in nearby Marina or Pacific Grove. Everyone’s Harvest also opened a market this year in Alisal in Salinas.

Participants receive weekly $25 vouchers for six months, they get nutrition counseling from their health centers and they have to attend periodic check-ups for measuring health indicators.

Funding for the vouchers comes from the hospitals as well as the Monterey County Gives campaign, USDA grants and local foundations, Norris said.

At the Seaside health center, pediatrician Nanette Millan-Macasinag said last year the program was a tough sell to parents who were mostly field workers or hotel employees with very little time to frequent farmers markets. It’s easier to shop at the grocery store where much of the food is already prepared, she said.

But the program got results. Of the 13 participants six decreased their body mass index, and seven maintained the same body mass index. Millan-Macasinag also conducted a control group which did not participate in the program and only 2 of those 13 patients decreased their body mass, four had no change and eight increased their body mass.

She asked the families about the value of the $25 voucher. Patients said it went a lot further at the farmer’s market than $25 does at Burger King. They said when they go out to eat, they come home and there’s no food, she said.

For Fink the results were immediate: he got his energy back and that was motivating, he said.

“Before I couldn’t get up out of a chair and do the things I wanted to with my son. Now I’m riding dirt bikes with him and playing paint ball,” he said. His wife has lost 40 pounds and her high blood pressure is gone.

Fink is surprised at how many of his friends are going through similar battles with their health, but aren’t ready to make necessary dietary changes.

“It’s a frustrating conversation,” he said. “Because the alternative you’re looking at is open heart surgery or something else pretty drastic.”

At Salinas Valley Memorial patients learn about diet and lifestyle changes through cardiac or diabetes classes and they have to sign an agreement that they will attend every weekly market from May to October, said Tiffany Montana DiTullio, senior administrative director of patient experience and community wellness at Salinas Valley Memorial Healthcare System.

Hospital dieticians provide support by creating recipes for produce offered at the market.

And Everyone’s Harvest recruits local chefs for cooking classes at the markets. Attendees get additional produce vouchers, Norris said.

These programs also benefit farmers markets which are able to sustain business in neighborhoods that otherwise couldn’t support them. Langholtz of Wholesome Wave talked to a farmer selling at a produce prescription market in New York’s Harlem neighborhood who sells at six of these markets in low income areas. He said half of them would fold without the produce prescription business.

There has been some federal support for these types of programs as well. The Agricultural Act of 2014, (the Farm Bill), included $100 million to support the newly created Food Insecurity Nutrition Incentive Program. That’s a national healthy produce program modeled after programs like those supported by Wholesome Wave, that have doubled the value of Supplemental Nutrition Assistance Program (SNAP) dollars (modern day food stamps), when program participants use them to buy produce at farmers markets.

Everyone’s Harvest was the first on the Monterey Peninsula to accept Electronic Benefit Transfer (the debit card for SNAP) and to double the value of those dollars when SNAP recipients use them to buy produce, Norris said.

“So many of these people who grow this good food don’t have access to it,” he said. “Our hope is these markets will take hold in places that for-profit markets maybe wouldn’t venture into.”