Upon encountering a patient grappling with high blood pressure, diabetes, or any other chronic ailment, Mackenzie Sachs, a registered dietitian serving the Blackfeet Reservation, doesn’t instinctively advocate for medication as her initial solution.
Alternatively, if the patient lacks convenient access to fruits and vegetables, they will be enrolled in the FAST Blackfeet produce prescription program. The program, known as Food Access and Sustainability Team (FAST), offers vouchers to individuals with illnesses or limited food security, helping to lower the costs of nutritious foods. Since 2021, Sachs has advised 84 patients to follow a fruit and vegetable treatment plan, resulting in enhanced health due to increased intake of vitamins, fiber, and minerals, according to her observations.
She expressed, “The vouchers instill in me a sense of confidence regarding the patients’ ability to purchase the foods I am suggesting for them. I am aware that other dietitians lack this assurance.”
Sachs, along with many other healthcare providers in Montana, now has the opportunity to prescribe something different – not medication, but fresh produce.
The Montana Produce Prescription Collaborative, or MTPRx, brings together several nonprofits and health care providers across Montana. Led by the Community Food & Agriculture Coalition, the initiative was recently awarded a federal grant of $500,000 to support produce prescription programs throughout the state over the next three years, with the goal of reaching more than 200 people across 14 counties in the first year.
Partners involved in the program assess patients for chronic health conditions and their access to food. Patients who meet the criteria are given prescriptions in the form of vouchers or coupons, which can be used to obtain fresh fruits and vegetables from farmers markets, food banks, and stores. In the winter season when farmers markets are closed, MTPRx partners depend more on stores, food banks, and nonprofit food organizations to ensure that patients continue to receive their necessary supply of fruits and vegetables.
The irony is that rural areas, where food is often grown, can also be food deserts for their residents. Katie Garfield, a researcher and clinical instructor with Harvard’s Food is Medicine project, said produce prescription programs in rural areas are less likely than others to have reliable access to produce through grocers or other retailers. A report from No Kid Hungry concluded that 91% of the counties nationwide whose residents have the most difficulty accessing adequate and nutritious food are rural.
Garfield emphasized that diet-related chronic illness has become an epidemic in the United States. He pointed out that the significant prevalence of chronic conditions comes with substantial human and economic consequences. Therefore, the primary focus of health care policy should currently be on finding ways to effectively reduce the occurrence of diet-related chronic diseases.
Produce prescription programs have been around since the 1960s, when Dr. Jack Geiger opened a clinic in Mound Bayou, a small city in the Mississippi Delta. There, Dr. Geiger saw the need for “social medicine” to treat the chronic health conditions he saw, many the result of poverty. He prescribed food to families with malnourished children and paid for it out of the clinic’s pharmacy budget.
A study by the consulting firm DAISA Enterprises identified 108 produce prescription programs in the U.S., all partnered with health care facilities, that launched between 2010 and 2020, with 30% in the Northeast and 28% in the Midwest. Early results show the promise of integrating produce into a clinician-guided treatment plan, but the viability of the approach is less proven in rural communities such as many of those in Montana.
In Montana, 31,000 children do not have consistent access to food, according to the Montana Food Bank Network. Half of the state’s 56 counties are considered food deserts, where low-income residents must travel more than 10 miles to the nearest supermarket — which is one definition the U.S Department of Agriculture uses for low food access in a rural area.
Studies indicate that both long distances to travel and limited transportation options pose substantial obstacles in obtaining nutritious food.
“Living in an agriculturally rich community, it’s easy to assume everyone has access,” said Gretchen Boyer, executive director of Land to Hand Montana. The organization works with nearby health care system Logan Health to provide more than 100 people with regular produce allotments.
According to Boyer, the prevalence of food and nutritional insecurity is widespread, and individuals who have grown up in long-term poverty likely have not had consistent access to fruits and vegetables throughout their lives.
According to Merry Hutton, regional director of community health investment for Providence, a healthcare provider operating clinics in western Montana and one of the MTPRx clinical partners, over 9% of adults in Montana suffer from Type 2 diabetes, while approximately 35% are in a pre-diabetic state.
Brittany Coburn, a family nurse practitioner at Logan Health, frequently encounters such conditions in the community she serves. However, she strongly believes that produce prescriptions hold immense potential to enhance the health of patients.
She stated that incorporating real food into our diets is crucial, as it can have a positive impact on diabetes, cholesterol levels, and blood pressure. Increasing the consumption of fruits and vegetables specifically can even lead to the reversal of certain forms of diabetes.
Produce prescription programs hold the potential to alleviate the financial burden of treating chronic health conditions, which currently strain the overall healthcare system.
Garfield emphasized the importance of considering food as an integral part of healthcare treatment and prevention strategies, stating that doing so would lead to better results and lower healthcare expenses. He further argued that if diet plays a significant role in determining health outcomes in the United States, it should be given utmost priority in future health policies; otherwise, it would be a wasted chance.
The question is, do food prescription initiatives work? They typically lack the funding needed to foster long-term, sustainable change, and they often fail to track data that shows the relationship between increased produce consumption and improved health, according to a comprehensive survey of more than 6,000 studies on such programs.
According to organizers, MTPRx emphasizes the importance of data collection, with partners and healthcare providers monitoring the impact of program participation on vital health indicators like blood sugar, lipids, and cholesterol levels.
Bridget McDonald, the program director at CFAC, expressed her strong desire to witness these results and utilize them to establish a new norm. She emphasized the importance of popularizing the “food is medicine” movement and integrating it into mainstream society.
Sachs admitted that there are certain conditions that typically cannot be reversed, implying that some patients may require medication as well.
Nevertheless, the partners of MTPRx hold the aspiration of presenting a compelling argument regarding the inclusion of produce prescriptions as a feasible clinical intervention on a broader level.
Sachs expressed, “If we come together, there is a possibility that we can collectively support and push for funding and policy reform.”
