Priority Nutrition Strategy: Fruit and Vegetable Voucher Incentives and Produce Prescriptions

Background

Eating enough fruits and vegetables each day is an important way for people to improve their health. Yet only 1 in 10 US adults eats enough fruits and vegetables every day.

Many groups have limited access to affordable, healthy foods such as fruits and vegetables. These groups include people living in rural areas, tribal communities, and neighborhoods where most residents have lower incomes. People with disabilities may also be affected. In addition, people in some racial and ethnic groups may not have access to culturally preferred, healthy foods.

Two key, evidence-based public health strategies that improve consumption of fruits and vegetables are fruit and vegetable incentives and produce prescriptions programs. These programs improve both affordability and access to healthier food. They are often coupled with education programs on food, cooking, and nutrition necessary for a healthy diet. They also increase market demand for fruits and vegetables, which can increase sales for local farmers, food hubs, aggregators, distributors, and retailers.

Some states and communities have existing fruit and vegetable incentive and produce prescription programs that could be expanded. Some insurance payers or health systems may offer programs that states and communities could adapt and expand. A variety of partners, including growers, food retailers, and community members, typically need to be involved in program development, communication, coordination, implementation, and evaluation. Planning and operating these programs require working across sectors, including health care, transportation, and agriculture. Include sectors that can ensure a sufficient supply of culturally preferred fruits and vegetables.

Potential Activities

State

• Engage representatives from Medicaid programs (including state agencies, payers, and health systems) in implementation, expansion, and evaluation of fruit and vegetable incentive or produce prescription programs.+
• Support policies that increase participation in incentive or prescription initiatives, such as state benefit coverage for patients enrolled in these programs or state waivers that provide resources or funding for these programs.+
• Convene state agencies to align activities related to incentive or prescription programs. Relevant state agencies include those involved in food system, feeding programs, disaster response, environmental sustainability, health care, aging services, and nutrition security. Integrate these activities into new or existing state food plans or charters.*
• Support expansion of technologies that allow food businesses to accept program vouchers as payment, for example statewide payment systems or online grocery platforms.+
• Share resources (such as data or staffing) that support incentive or  prescription programs.*
• Train state partners to operate incentive and  prescription programs.*

State and Local

• Coordinate partnerships across organizations to make it easier for them to apply for funding and get access to resources and data, program infrastructure and staffing, program enrollment support, and evaluation support.*
• Strengthen or launch regional, state, or local food policy councils of diverse, cross-sector food system partners. These groups may include feeding programs, disaster response, environmental sustainability, food security, health care, producers, distributors and retailers, and community members. Include people who have experienced lack of access to affordable, healthy foods.+
• Train staff and all partners on best practices to reduce health disparities, and include approaches that are trauma-informed.+
  
• Create or expand a communication campaign(s) to priority communities to promote awareness and use of fruit and vegetable incentive and produce prescription programs and improve understanding of the importance of nutrition to health. Be sure the materials are culturally and linguistically appropriate for the priority groups.+
• Engage community members, food systems representatives, and other experts to ensure that initiatives promote equity in the food system. For example, people who have lacked access to fruits and vegetables should be on the project team and help guide program development, implementation and evaluation.
• Connect incentive and prescription programs to local food sources, including farmers and food business owners from socially disadvantaged groups. Also find out if redemption sites are offering culturally preferred foods. Help partners identify priority populations and learn how to tailor their nutrition education and marketing to these populations. Data sources that can inform these efforts include the Child Opportunity Index and Social Vulnerability Index.*
• Engage state and local transit authorities and planners to address barriers to taking public transit to sites that offer incentives or  prescription redemption.+

Local

• Help local program providers identify funding sources for developing and implementing pilot programs, for example to buy produce, fund the incentive, or support nutrition education.*
• Help partners conduct community needs assessments [PDF-7.5MB] that inform development or expansion of fruit and vegetable incentive or produce prescription programs.*
• Connect incentive and  prescription programs to local food sources, including farmers and food business owners who are members of communities being served.+
• Support the use of technologies that allow food business to accept incentive vouchers as payment. For example, train partners to use these systems or support diverse food businesses to participate in these systems.+
• Support local policies that increase participation in incentive or prescription initiatives. Such policies could provide funding that makes it easier for food retailers that accept these incentives or prescriptions to sell produce.
• If not already available, create on-site food pantries at hospitals and clinics where space and staffing exist, and expand referral of patients and staff to these resources.*
• Support local farmers, food distributors, and business owners, including those who are members of the communities being served, to help them grow, distribute, and sell fruits and vegetables needed for voucher incentive or produce prescription programs.+
• Strengthen links between regional food hubs or collective buying approaches to provide sources of culturally preferred foods for fruit and vegetable incentive and produce prescription programs.+
• Train local partners to implement fruit and vegetable incentive and produce prescription programs.*
• Build clinical-community linkages to learn what assets are already available, use screening and referral platforms, and engage community health workers.+

Resources

Supporting Food and Nutrition Security Through Healthcare [PDF-12.2MB]
Guide focuses on approaches that help the healthcare system provide nutritious food, or resources to access nutritious food, to patients with high risks of food insecurity.

Nutrition Incentive Hub
Resources to support nutrition incentive and produce prescription projects. Topics includes reporting and evaluation; diversity, equity and inclusion; and marketing and communications.

Nutrition Guidelines for the Charitable Food System [PDF-4.1MB]
Standards for use in food banks or pantries.

Food System Coalitions

Structuring Your Food Policy Council
Blog post explores best practices for structuring food policy councils.

Get it Toolgether: Assessing Your Food Council’s Ability to Do Policy Work
Toolkit for any food system group that works (or aspires to work) on policy, with self-assessment checklists in six areas: organizational assessment, advocacy goals, plans and strategies, conducting advocacy, advocacy avenues, organizational operations to sustain advocacy, and policy implementation.

Food Policy Council Self-Assessment Tool
Tool to assess food policy members’ perceptions of their council’s organizational capacity, social capital, and council effectiveness.

Review of State Food Plans and Charters
Overview of US trends and a directory of state and regional food systems plans and charters.

Health Equity

An Introduction to Incorporating Diversity, Equity, and Inclusion (DEI) into Nutrition Incentive Program Research and Evaluation [PDF-2.2MB]
Details how to use a DEI lens when researching and evaluating nutrition incentive programs. Includes examples and questions for consideration.

Delivering More than Food: Understanding and Operationalizing Racial Equity in Food Hubs [PDF-7.4MB]
Presents themes, findings and key takeaways for food hubs engaging in racial equity work.

Food Sovereignty Assessments: A Tool to Grow Healthy Native Communities [PDF-4.5MB]
Background on food sovereignty assessments and findings from several assessments completed in native communities with funding from the First Nations Development Institute.

Additional Health Equity Resources
Information and strategies to help communities, programs, and initiatives work to remove barriers to health and achieve health equity. Includes links to health equity data.

What Others Are Doing

Supporting Food and Nutrition Security Through Healthcare [PDF-12.2MB]
Guide focuses on approaches that help the healthcare system provide nutritious food, or resources to access nutritious food, to patients with high risks of food insecurity.

Washington’s FV Incentive Program
The state’s Fruit and Vegetables Incentive Program benefits people who are food insecure, the agricultural industry, and retailers across the state.

Fresh Bucks Produce Prescription Program
Program in Marion County, Indiana, fosters healthier eating habits to prevent and manage chronic diseases while improving nutrition insecurity.

New Mexico Fresh Rx
Produce prescription program provides incentives for patients to complement their current medical care by purchasing nutritious, New Mexico-grown produce.

Navajo FVRx
Produce prescription program allows families to buy fruits and vegetables at local stores on Navajo Nation with vouchers provided by clinic providers and community health workers. Participating stores are encouraged to offer a variety of fruits and vegetables, including locally-grown produce from Navajo farmers.