The Food-Is-Medicine movement is growing; farmers need to be at the table to ensure these programs source food locally and regeneratively
The food-is-medicine movement — some prefer the name “food-as-health” — is moving at lightning speed. Seven states (Arizona, California, Massachusetts, New Jersey, North Carolina, Oregon, and Washington) have passed a Medicaid 1115 waiver that covers additional food and nutrition benefits. Four additional states are in the approval process for this waiver (Delaware, Illinois, New Mexico, and New York), and Missouri is close to launching a similar 1915(c) waiver. North Carolina’s Health and Human Services Department alone invested $650 million in a Healthy Opportunity Pilot, which includes produce prescription, housing and transportation.
Millions of healthcare, Farm Bill and other grant dollars are being spent to help supply those in need with healthier food. This is a good thing. Yet where is the investment in the farmers who take on all the risk to grow this healthy food? Is the medicalizing of food as a health insurance benefit a potential problem, or the holy grail? Programs throughout the nation are billing Medicaid Managed Care and Medicare Advantage programs for food, but is that money staying in the local economy and supporting local farmers?
A few programs in the nation are looking at food as medicine through a full-system lens, using their dollars both to improve health outcomes and to support regenerative farms. Recipe4Health in California grows regenerative fruits and vegetables for their produce prescription program. A $6.6 million National Institutes of Health project in the Mississippi Delta called Delta GREENS is sourcing from local farmers for its 300 program participants. FreshRx Oklahoma (featured in the April 2023 issue of this magazine) sources and aggregates from 25 local small-scale farmers with good soil health practices.
FreshRx estimates it has saved the state of Oklahoma nearly $2 million dollars in healthcare costs in two years while serving only 155 diabetic participants. This is based on an average reduction of 2.2 points in the HbA1c levels of those who see some type of reduction, which is about 70-80 percent of the participants. In the program’s second year, one participant reduced their HbA1c level from 13.6 to 5.4 and lost 72 pounds! This is the difference between keeping a limb or not — even between life and death.
FreshRx is also working with the Muscogee Creek Nation to source locally to provide culturally appropriate fruits and vegetables to their tribal members. This is part of an effort by the federal Indian Health Services to conduct a produce prescription demonstration project for five tribal nations (Muscogee Creek Nation, Laguna Healthcare Corporation, Navajo Health Foundation, Pascua Yaqui Tribe, and Rocky Boy Health Center).
The healthcare industry is benefitting from these interventions; it’s time that they invest these savings back into the organizations that are helping participants make these achievements.
Programs who have been doing this work for decades, including large-scale food-as-medicine programs, are still slow in connecting soil health to nutrition. Many regenerative agriculture groups are not promoting the human health component as strongly as they could. Senior-living groups aren’t really highlighting it at all. Systems like healthcare, public health and long-term care may speak about food as medicine, but most are completely disconnected to how nutrients are translated from soil to plant to human. David Montgomery’s new book, What Your Food Ate, provides much insight and research to support this claim. Sourcing local itself preserves nutrients by shortening the last mile, which positively affects the workforce, economy and environment. Why allow corporations to run these programs without accountability on sourcing?
With $691 million being spent on Local Food Purchasing Assistance grants and $12 million up for grabs in 2024 for Farm-to-School grants, along with the increase in produce prescription programs and the federalization of medically tailored meals, you would assume farmers could sell and rely on these new and developing markets. Yet in many programs that are meant to help farmers and local procurement, the grantors and grantees are having challenges spending these dollars and executing these programs. Based on community voices and needs, these programs have many barriers and were not initially designed with the small-scale farmer in mind. Technical assistance and guidance for farmers all the way through the process is vital, and many programs did not build this capacity into their execution plan.
A big solution that could be more widely used is a CSA purchasing agreement, where farmers are paid partially upfront for a certain number of crops. As we all know, 20,000 pounds of carrots does not come out of thin air, and expecting a farmer to take that risk alone is unreasonable. Programs like FreshRx Oklahoma and Delta GREENS are making considerable upfront investments in local farms to supply their produce prescription programs.
The 1115 waiver creates a legal requirement for state Medicaid offices to pay for food as an insurance benefit for low-income individuals. Although Medicaid Managed Care already has the freedom to pay for these types of programs, an 1115 waiver would provide a more articulated pathway and requirements. This year, two states — Oklahoma and Alaska — were chosen by Harvard University to receive technical assistance to help 1115 waiver coalitions add legal language. The mission in Oklahoma is to include a percentage requirement of local food purchasing to support Oklahoma agriculture; we consider this not only the right thing to do but a viable business plan with a substantial ROI. This is not only a health improvement plan but also a plan to use dollars more efficiently and effectively to stimulate and resurrect rural economies. This is similar to some DoubleUp nutrition incentive programs in the way they require grocery stores to increase their local sourcing.
The NPPC (National Produce Prescription Collaborative) is creating a new billing code through CMS Centers for Medicaid and Medicare and is working with legislation to make food a permanent part of the healthcare industry. It took 10 years for produce prescription to be a permanent part of the Farm Bill, and it was only two committees that had to agree. With healthcare and its many overlapping interests, there are 10 committees to convince; this will take considerable heavy lifting.
On the positive side, however, on October 18th, the Tufts Food Is Medicine Institute was launched. FIM is “a new, cross-university collaborative effort based at the Friedman School of Nutrition Science and Policy, bringing together experts from across the university with other local and national partners to advance FIM research, training, patient care, and community and policy engagement…. This first-of-its-kind Institute will serve as a catalyst to drive change, improve health, reduce health disparities, and create a more equitable and resilient healthcare system that recognizes the power of nourishing food.” In their grand opening event, the president of the FIM Institute, Dr. Dariush Mozafarrian, spoke specifically about supporting local procurement and resilient food systems, even mentioning regenerative agriculture by name.
Agriculture must be at the table for these conversations. Healthcare, public health, long-term care and agriculture movements are really one movement, working together to move this needle from the early adopter phase to critical mass. Requirements for local sourcing in food-is-medicine programs is vital for using dollars effectively to get to the root of the issue — and also to create something we so desperately need: community and connection.
Food insecurity and poor health outcomes come from a root cause, and if programs do not become conscious about using dollars for local sourcing, we are simply putting another band aid on this colossal issue. The benefits of keeping money in the community are tangible, exponential and quantifiable, and they are vital to reconnecting underserved communities.
Erin Martin is a gerontologist and is the director of FreshRx Oklahoma. Learn more at freshrxok.org.
