Leafy Greens Can Keep You Healthy, and Your Doctor Can Prescribe Them
Despite all the evidence linking a healthy diet to a healthy body, few doctors have training in nutrition, or much influence on what their patients eat.
But a Washington, D.C.-based organization has aimed to changed that. A group called DC Greens launched a program in 2012 that enables doctors and other health care providers to write “prescriptions” for fruits and vegetables, which most Americans don’t get enough of.
It works like this: The health care providers zero-in on patients who are overweight and at high risk for developing diet-related diseases, including diabetes and high blood pressure. At monthly visits to their doctors, the patients get a prescription, which they can redeem for a voucher at any of the district’s 50-plus farmers markets.
Washington, D.C., Food Desert Map
- DC Greens
- Low-income census tracts where a significant number or share of residents is more than 1 mile (urban) or 10 miles (rural) from the nearest supermarket.
In Washington, D.C., food deserts are concentrated south of the Anacostia River. DC Greens is located in northwest D.C. and seeks to increase access to affordable produce for low-income people across the city, specifically through doctors providing produce prescriptions. Economic Research Service (ERS), U.S. Department of Agriculture (USDA). Food Access Research Atlas.
In 2015, DC Greens revenues were close to $1.1 million, the bulk coming from donations from foundations, corporations and individuals, government grants and contracts. In the five years since the program began, DC Greens has tracked progress, finding that weights have dropped—and, in a somewhat unexpected outcome, the patients more consistently saw their doctors.
The program has worked in a couple of ways, by providing healthy food for low-income people in areas with little access to fresh, affordable produce, and enabling doctors to take a more holistic approach to health care by treating food and diet as medicine.
But for Lauren Shweder Biel, the co-founder of DC Greens, the concept took a while to develop, and finding the right strategy meant finding an answer to a question no one was asking.
Here, we ask Shweder Biel a few questions of our own.
How did DC Greens come together?
It really started as a collaboration with my co-founder, Sarah Holway. She was a teacher at Bancroft Elementary, which was the first school invited to plant the White House garden with Michelle Obama. There was a lot of national attention on the school, but we realized there wasn’t enough support for most school gardens.
I was trying to get a farmers market in my neighborhood (Glover Park) and was on maternity leave. I got really involved with the DC Farmers Market Collaborative, which is a body that brings together farmers markets to address food access.
Each of us kept raising our hands and said we’d love to organize a training that brings together teachers or get more funding for food access.
How was it meant to be different from what existed already?
Honestly, when we started out, we didn’t know what direction we were headed in. I had read “The Omnivore’s Dilemma,” and I knew there was this whole food system that had so many breaks and cracks in it. We were looking across the field in D.C. at the time. There were people involved in hunger alleviation or farmers markets or school gardens. There were a lot of different silos, so we wanted to build an organization that would work across those—work across education and policy—to be a service to other service providers. There’s a lot of collaboration in D.C. We try to do work within that collaboration. At the end of the day, we realized you need some glue, some connective tissue.
How did the idea for the prescription program come to you?
The original idea came from Wholesome Wave, which was a national nonprofit. Gus Schumacher, who founded Wholesome Wave, stopped by the farmers market and we talked. It felt like a light bulb went off, and I knew I wanted to bring this to the district.
We try to bring national best practices in the service of local solutions. What matters is: Does it work, and if so, how can we bring it here? We were one of the very early partners on the national front and over the years we were able to make it on our own. We no longer receive funding from Wholesome Wave. It comes from the Department of Health and AmeriHealth Caritas (the district’s Medicaid provider). We wanted to take this idea and move it out of the philanthropic sector and bake it in to how the city does business.
What’s your elevator pitch for explaining how the program works?
Doctors write a prescription that can be filled at any farmers market in the city—and there are 53—for an allotment based on family size. They go to their doctors once a month. The doctors take all the health metrics and decide who might be a good candidate. Every week they get an allotment of checks that are pre-certified for farmers that sell fruits and vegetables, so the farmers are compensated and the patients are receiving the checks. The prescription is for a whole month.
Have you measured the impact?
We’ve found that half of the patients have seen a reduction in body mass index (BMI), and patient retention rates go up because this creates a very tangible reason to go see their doctor.
How do you measure success?
I’m always trying to push toward the long term and large-scale systems change. For me, success is when it’s funded by health care providers because they see healthy food access as preventative health that’s good for their bottom lines. They see it as business proposition, not a charitable move.
Right now we serve about 300 to 600 individuals a season, which is not a huge intervention for a program like this. I want access to healthy food to be seen as a basic human right, and I think the health care system is the way to deliver that.
How could this be a model for other business? How would this work in, say, Cincinnati?
It’s definitely something that can be replicated, and there are other places across the country piloting this. In Cincinnati, in fact, ProMedica is a major health care provider, and they’re on the front line in thinking about diet [as] a root cause of so many health problems. I think there’s a lot of interest and impetus in this right now. There’s sort of this wish that connections just happen, but until something is deeply baked into how our health care system works, these programs need shepherding.
Has this project sparked other ideas?
One of the things that been very interesting is seeing how much of a motivator food access is for patients. It makes perfect sense that if people are struggling to feed themselves, if we’re finding new sources of food, it would be very motivating.
This isn’t a fully baked idea, but given the move that’s happening across health care—on value-based care—the patients are staying inside a continuum of care. It feels like a moment where we’re recognizing the power of access to healthy food. It has the potential to be an assist to the health care system in this moment of change. We’re working with AmeriHealth on this. What sorts of interventions would be important behavior drivers that would help people make good clinical choices? We’re thinking about how this could extend beyond farmers markets.