Steve Friess

In Michigan, doctors prescribe fruit and vegetables

Ypsilanti is one of many communities piloting a program in which patients are provided tokens for fresh produce

YPSILANTI, Mich. — In June, Alice Newell’s doctor became alarmed by her ongoing weight gain and unhealthy eating habits. Joint and ankle pain had forced the 49-year-old nursing assistant to stop working more than a year earlier, forcing her to rely even more heavily — as financial stress so often does in America — on inexpensive foods loaded with calories, salt and processed sugars.

His solution was to write Newell a “prescription” for fruits and vegetables, enrolling her in an innovative program in which she could take the small form he provided to the local farmers market and receive $10 to spend there each week for 10 weeks. Before she receives the money, in the form of $1 wooden tokens, she must chat with a community health worker who marks down on her form how much fresh produce she ate the prior week and as well as her progress on her exercise goals.

“So you’re going to eat three cups of fruit and vegetables daily this week, right?” asks the health worker, Anne Davis, asks. “And how are you doing with your walking?”

“I’m up to an hour a day,” says a grinning Newell, shaking her head. “I can do that now. I already lost 10 pounds this summer. Ten to go!”

“You are doing awesome!” Davis beams back, handing over tokens that vendors at the farmers market accept as cash. “You’re doing so good!”

The Prescription for Health project, run by the health department in Ypsilanti, a city about 30 miles west of Detroit and funded by the Michigan-based Kresge Foundation, is one of a growing number of efforts around the United States to encourage low-income people to visit farmers markets in order to eat better. Typically started up as pilot programs offered and funded locally, this year they’ve earned the hearty endorsement of the U.S. Department of Agriculture in the form of $31.5 million in block grants to communities in 26 states providing incentives for the poor to consume less junk food and more healthy fare. The money is part of about $100 million allotted in the Food Insecurity Nutrition Incentive component of the 2014 Farm Bill, the rest of which must be distributed via grants through 2018.

Alice Newell's exercise card from the summer.
Steve Friess

“The more we connect households to healthier foods, the more it will result in improved health situations for those children and adults,” Agriculture Department Undersecretary Kevin Concannon said. “Foods like tomatoes and other vegetables have not been subsidized in this country, unlike corn or cotton or peanuts. The idea is to make it effectively more affordable for some households.”

New York City pioneered the concept a decade ago in a program called Health Bucks that give $2 in certificates to farmers market patrons for every $5 spent on fresh produce from the Supplemental Nutrition Assistance Program, or SNAP, the funds commonly referred to as “food stamps.” Overall, shoppers spend more than $1 million in food stamps at farmers’ markets each year, unlocking an additional $400,000 per year in Health Bucks to spend.

“The demand and the numbers that we have show that people want to see their family eat healthy food and we’re helping that happen,” said Cheryl Huber, assistant director of GrowNYC, a non-profit that operates 53 of the city’s farmers markets and gave out $260,000 in Health Bucks last year. “It’s great for the farmers, too, because that’s money they wouldn’t have gotten otherwise, and obviously it keeps people coming back to the market all the time. That’s really, really important.”

While the program has been widely embraced in New York and Ypsilanti, in other parts of the nation execution has been a bigger challenge. In South Carolina, for instance, the Legislature allotted $3 million for their Healthy Bucks program, but the rollout has been slow because only a third of the state’s farmers markets accept SNAP money. Many of the markets are also not near public transportation and are located in wealthier areas to take advantage of well-heeled, health-conscious consumers willing to pay more for premium foods.

Last year, in South Carolina’s first program, the state doubled SNAP money — giving shoppers up to a $5 match per farmers market day — at just six farmers markets around the state. This year, the program expanded to 15 markets, but through the first half of the year the state still only provided $8,200 in Healthy Bucks.

“A lot of farmers markets are not in areas necessarily that low-income people can access or are wanted,” said Carrie Draper, a social worker at the Center for Research in Nutrition and Health Disparities at the University of South Carolina. “One of the ladies who runs a farmers market talks about how she doesn't think that people on SNAP will be able to afford to buy fresh fruits and vegetables at the farmers markets, but then she tells me how angry she is that people who are on SNAP can use their money to buy Reese’s Pieces. A low-income person can’t win.”

The program is also a means of introducing low-income people to both the growing number of farmers markets and their farm-fresh offerings. Recipients find a more social shopping experience in which they interact with the growers, learn about new ways to prepare food and discover vegetables they’d never tried or heard of before. Newell, for instance, started her walk around the market in Ypsilanti intent on buying onions, tomatoes, cucumbers and lettuce. One farmer turned her on to purple China long beans and another explained the versatility of dill. “My daughters are like, ‘Ma, we tried some bok choy, and it was good!” she said.

“What was surprising to me was how excited people got because they saw immediate health benefits,” said Lois Plantefaber, social worker with St. Joseph Mercy's Neighborhood Family Health Center in Ypsilanti, which refers patients to the program. “I can’t tell you how many people have said, ‘My blood pressure went down. My blood sugar went down.’”

Another Prescription for Health recipient, 36-year-old Valerie Spratling, is a second-year enrollee. After she ran out of the tokens for the year, she says, she nonetheless kept returning to the farmers market with her 8-year-old daughter and 10-year-old son. The program has forced her to become more alert to how to ward off diabetes, she said, and heightened her awareness of how delicious good produce can be.

“The flavor and the tasting of the vegetables is different than at [supermarkets],” said Spratling, a day-care worker. “The zucchini, the squash, the green beans, the strawberries were good. They’re just fresher. They’re worth a little more money if I have it. I don’t always have it, though.”

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