When Katie Molitor joined the Columbia Center for Urban Agriculture in 2019, she knew Boone County needed to put nutritious and affordable food on more tables.
Two years later, she came up with a plan: give patients a year’s worth of prescriptions for fresh fruits and vegetables to supplement their diet. The idea caught on and the result is Produce Prescription, which makes fresh products available by prescription.
Compass Health will write the prescriptions for families with children under 19 who can exchange them for production tokens at the Columbia Farmers Market. The vouchers can be exchanged at one of the market traders.
Since 2021, the program has distributed approximately $118,000 in fresh produce, with families receiving up to $20 each week.
“This appears to be a very effective type of public health intervention to help people with chronic diseases and people who are food insecure,” Molitor said.
[subhed]The bigger picture
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The United States is embroiled in a health and hunger crisis, including in the Midwest. Food insecurity is defined by the United States Department of Agriculture as the lack of consistent access to enough food to live an active, healthy life.
At least 20,000 Boone County residents were considered food insecure in 2021, according to Feeding America.
Food insecurity has cascading consequences, not only on health, but also on the wallet. To cope with the inaccessibility of healthy food in recent years, 61% of households purchased the least expensive food available, even if it was not the healthiest option, according to the Food Assistance and Hunger in the Heartland 2021 report.
The reality is that nutritious food can be difficult to obtain and unaffordable for many people.
On a larger economic scale, an estimated 90% of the US’s $4.3 trillion in annual health care costs is spent on medical care for chronic diseases, according to the American Heart Association.
A national intervention to tackle 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 has no single definition.
Rather, it is underlined by the shared sentiment that the effects of diet-related diseases can be mitigated through health interventions.
Such efforts include promoting food safety and education, offering product vouchers to people experiencing diet-related illness or food insecurity and writing prescriptions for nutrient-dense foods, much like the program in Boone County.
“The Columbia Center for Urban Agriculture is all about Food is Medicine,” says Molitor. “We’ve had people tell us they’re no longer taking insulin, they’ve lost weight and their cholesterol has gone down.”
A look at the legislation
Last fall, the Biden-Harris administration stepped in and announced its support for legislation that would expand Food is Medicine interventions to some Medicare recipients, as well as those on Medicaid.
In a call to action, the administration urged states to “use all available federal authorities to expand coverage of ‘food is medicine’ interventions,” according to the report from the National Strategy on Hunger, Nutrition and September 2022 Health.
According to the report, a Section 1115 waiver under the Social Security Act would allow Medicaid to officially implement pilot programs to cover the costs of nutritional interventions for patients.
Although MO HealthNet, the state arm of Medicaid, has active Section 1115 waivers for postpartum women and children in foster care, it does not have a waiver for nutritional interventions. If Missouri were to apply, the waiver would be in effect for five years, with extensions of 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 and Northeast Missouri remain the backbone of support for the Columbia area.
The mission of the Food Bank
Alma Hopkins, a registered dietitian at the Food Bank, is acutely aware of the connection between food insecurity and chronic disease. For every ten people the bank serves, she says, four to six people live with chronic, diet-related diseases.
Since joining the Food Bank team, Hopkins has addressed Boone County’s nutritional deficiencies through lessons on using, storing and utilizing fresh produce.
In doing so, her program has joined the growing list of Missouri initiatives focused on promoting health equity through nutritious meals. By partnering with agencies and serving mobile food banks, the Food Bank for Central and Northeast Missouri will have served individuals and families 118,000 times through mobile food bank distribution by 2022.
Although the bank has offered fresh produce for years, its communications director, Katie Adkins, said it is still making progress on the food bank’s canned goods model.
“Overall, the food bank is moving toward fresh, healthy distribution,” Adkins said. “Right now, about 64% of what we share is what we call ‘food to encourage’.”
The gold standard includes fresh produce, dairy, lean protein, and canned and frozen fruits and vegetables. Hopkins also advocated whole foods, emphasizing the healing power of vegetables, fruits and legumes.
“It’s really overwhelmed by the amount of testimonials that say food is medicine,” Hopkins said. “For example, green leafy vegetables, spinach, kale. They are wonderful resources. They help slow macular degeneration, which is an aging process that causes vision loss.”
In addition to adding cooking classes with her new Teaching Kitchen, Hopkins’ duties have historically included offering food tastings, providing food safety materials and creating health-conscious recipes for the public. In her words, the goal is simply “to increase appetite for the foods that keep people happy and healthy.”
However, while a holistic approach to treating disease is not new, little research has been done on a consistent or large enough scale to quantify the healing potential of food.
Meanwhile on the market
In addition to the Produce Prescription program, the Columbia Farmers Market has two programs that help people receiving food assistance, both designed to get fruits and vegetables from vendors’ gardens to consumers’ kitchens.
The Access to Healthy Food program targets recipients of the Supplemental Nutrition Assistance Program or the Women, Infants and Children program who are residents of Boone County and are seniors, have a disability, or have children age 19 or younger living at home.
To receive matching benefits, recipients can use their EBT card for any amount or offer a cash match and receive up to $35 in tokens. These tokens can then be exchanged for eligible items at approximately 60 merchants in the marketplace.
“The Access to Healthy Food program has grown this year with voucher recipients coming in,” said Jon Weekley, assistant manager of the farmers market. “In our peak season, we would have about 100 to 120 transactions on any given Saturday.”
The other program, Double Up Food Bucks, is a federally funded initiative that can provide up to $25 for SNAP recipients.
For people like Indiana Garcia, the program’s little green tokens were her ticket to bringing a little home and health into her new kitchen.
To pursue 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 stay were marred by uncertainty about all things food. Although 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 deal with the new customs and the new food,” Garcia said. “So you don’t want to spend money on things you don’t know if you’ll like or not, right?”
Then the Columbia Farmers Market came into the picture. Using the Double Up Food Bucks program, Garcia’s family can use SNAP benefits to maintain their desired lifestyle and try new foods without economic burden.
Garcia’s son, Luis Guevara, now 18, said he has grown to love experimenting in the kitchen. One of the family favorites is its pumpkin bread, made with ingredients purchased at the market.
“I made everything from scratch. I bought a pumpkin and mashed it,” Guevara said. “That was the time when the house was the messiest, but that bread was amazing.”
Garcia said having access to whole foods on a budget has given her children the ability to feel comfortable eating new things.
“He started baking and making pies,” Garcia said. “And they said, ‘Oh, they’re famous. They are very tasty. They’re good.’ And it was nice, because then I thought, ‘Finally we’re eating healthy.’ We eat what we can find locally, and at the same time we have a tight budget.”
Garcia said she wants to use the program as long as possible until she can pay it back.
“It gives you that moral obligation once you get good,” Garcia said. “This is a show I need to revisit and put some of my money into. Because it helped me, and it can help others too.”
This story originally appeared in the Columbia Missourian. It may be republished in print or online.