When Katie Molitor joined the Columbia Urban Agriculture Center in 2019, she knew Boone County needed to put nutritious, affordable food on more tables.
Two years later, he came up with a plan: Give patients a year’s worth of prescriptions of fresh fruits and vegetables to supplement their diets. The idea took root and the result was Produce Recipe, which enables fresh produce to be offered by prescription.
Compass Health prescribes families with children under 19 to exchange produce tokens at the Columbia Farmers Market. Coupons can be used at any market vendor.
The program has distributed nearly $118,000 in fresh produce since 2021, with families given up to $20 to spend each week.
“This seems like a really effective type of public health intervention to help people with chronic diseases and people with food insecurity,” Molitor said.
bigger picture
The United States, including the Midwest, is facing a health and hunger crisis. Food insecurity is defined by the U.S. Department of Agriculture as the lack of consistent access to enough food to live an active, healthy life.
As of 2021, at least 20,000 Boone County residents are considered food insecure, according to Feeding America.
Food insecurity has cascading effects not only on health but also on wallets. To cope with the lack of access to healthy food in recent years, 61% of households bought the cheapest food available, even if it wasn’t the healthiest option, according to the Food Assistance and Hunger in the Heartland 2021 report.
The truth is that accessing nutritious foods can be difficult and unaffordable for many people.
On a broader economic scale, an estimated 90% of the $4.3 trillion in annual health care costs in the United States is spent on medical care for chronic diseases, according to the American Heart Association.
One of the nationwide interventions to address the consequences of malnutrition is the Food is Medicine movement. There’s no single definition of the campaign, with initiatives supported by the Rockefeller Foundation, American Heart Association, Kroger and more.
Rather, it emphasizes the common view that the effects of nutrition-related diseases can be reduced through health interventions.
Such efforts include promoting food safety and education, providing product coupons to people facing diet-related illnesses or food insecurity, and providing prescriptions for nutrient-rich foods, similar to the program in Boone County.
“Food is Medicine for all of us at the Columbia Center for Urban Agriculture,” Molitor said. “There are people who say they have stopped using insulin, they have lost weight, their cholesterol has dropped.”
A look at the legislation
Last fall, the Biden-Harris administration announced its support for legislation that would expand Food is Medicine interventions to some Medicare recipients as well as Medicaid.
In a call to action, the administration urged states to “leverage all available federal authorities to expand the scope of ‘food is medicine’ interventions,” according to the administration’s September 2022 National Strategy on Hunger, Nutrition, and Health report.
The waiver of Section 1115 under the Social Security Act would allow Medicaid to formally implement pilot programs to cover the costs of nutritional interventions for patients, according to the report.
While MO HealthNet, the state’s affiliate of Medicaid, has active Section 1115 waivers for postpartum women and children in foster care, it has no waivers for nutritional interventions. If Missouri applies, the waiver will be valid for five years with renewals of up to three years.
Absent a Section 1115 exemption, organizations such as the Center for Urban Agriculture, the Farmers Market, and the Food Bank of Central and Northeast Missouri remain the backbone of support for the Columbia region.
Food Bank’s mission
Food Bank registered dietitian Alma Hopkins is acutely aware of the connection between food insecurity and chronic diseases. Four to six in 10 people the bank serves live with chronic, nutrition-related diseases, she said.
Since joining the Food Bank team, Hopkins has addressed Boone County’s nutritional deficiencies through classes on how to handle, store and utilize fresh produce.
In doing so, his program joins a growing list of Missouri initiatives dedicated to promoting health equity through nutritious meals. By partnering with agencies and providing mobile food pantry services, The Food Bank for Central & Northeast Missouri served individuals and families through mobile food pantry distributions 118,000 times in 2022.
While the bank has offered fresh produce for years, communications manager Katie Adkins said progress is still being made on the canned food banking model.
“Overall, the food bank is moving towards a fresh and healthy distribution,” Adkins said. “Right now, about 64% of what we share are what we call ‘foods to promote.’
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.
“The amount of evidence that says food is medicine is really overwhelming,” Hopkins said. “For example, green leafy vegetables, spinach, kale. They are great resources. “They help slow macular degeneration, which is the aging process of vision loss.”
In addition to adding cooking classes to the new Teaching Kitchen, Hopkins’ duties include offering historically food tastings, providing food safety supplies, and preparing health-conscious recipes for the public. In his words, the goal is simply to “increase appetite for foods that keep people happy and healthy.”
While a holistic approach to treating disease is not new, little research has been done consistently or on a large enough scale to measure the healing potential of food.
Meanwhile in the market
In addition to the Produce Program, the Columbia Farmers Market has two programs that assist food assistance recipients; Both are designed to deliver fruits and vegetables from sellers’ gardens to consumers’ kitchens.
The Healthy Food Access Program is available to recipients of the Supplemental Nutrition Assistance Program or Women, Infants and Children program who reside in Boone County and are elderly, disabled, or have children 19 years of age or younger living at home.
Recipients can swipe their EBT card for any amount to receive matching benefits or receive up to $35 in coins by providing a cash match. These tokens can then be redeemed on eligible products at approximately 60 merchants in the marketplace.
“The Healthy Food Access Program has grown this year with the arrival of voucher recipients,” said Jon Weekley, assistant manager of the farmers market. “During our busy season, we process approximately 100 to 120 transactions on a given Saturday.”
The other program, Double Up Food Bucks, is a federally funded initiative that matches SNAP recipients with up to $25.
For people like Indiana Garcia, the program’s small, green tokens were the ticket to bringing some home and health to their new kitchen.
Garcia left Nicaragua in 2020 to pursue a master’s degree. She was accompanied by her husband and two children, aged 6 and 15 at the time. For their children, the first six months of their residency were marred by uncertainty about everything food-related. 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 adapt to new traditions and new foods,” Garcia said. “So you don’t want to spend money on things you don’t know if you’ll like, right?”
That’s when the Columbia Farmers Market came into play. Using the Double Up Food Bucks program, Garcia’s family is able to use SNAP benefits to help them maintain the lifestyle they want and try new foods without any financial burden.
Garcia’s son Luis Guevara, now 18, said he enjoys experimenting in the kitchen. Her family’s favorites include pumpkin bread, which she makes with ingredients she picks up at the market.
“I made everything from scratch. I took a pumpkin and pureed it,” Guevara said. “It was the messiest time in the house, but that bread was amazing.”
Garcia said having access to whole foods on a limited budget gives her children the ability to be comfortable eating new things.
“She would start baking and making brownies,” Garcia said. “And they said: ‘Oh, acquaintances. They are delicious. They are good.’ It was nice because then I was like, ‘We’re finally eating healthy.’ “We eat locally available things and at the same time we have a very high budget.”
Garcia said he wants to use the program for as long as possible until he can afford to pay.
“When you’re good, it gives you a moral responsibility,” Garcia said. “This is a program that I need to look back on and put some of my money towards. Because it helped me and it can help others too.”
This story was first published in the Columbia Missourian. May be republished in print or online.