How Produce Prescriptions are promoting healthy behaviors across Michigan

One thing science proves for certain: Eating a diet that contains fruits and vegetables helps lower a person’s risk of cardiovascular disease, type 2 diabetes, obesity, and some forms of cancer. Despite that simple truth, only 9% of adults eat the recommended number of vegetables and 12% of adults eat the recommended amount of fruit, according to the Centers for Disease Control and Management (CDC). 

Part of the reason for these lower numbers is that many Americans are unable to afford fresh foods. The good news is that going to the store and buying produce with a prescription from a physician may be something more people are eligible for than they realize.

“Produce Prescription (PPR) programs are an extension of food access and nutrition incentive programming with a health care focus on promoting healthy behaviors for eligible patients,” explains Bella Pagogna, Produce Prescription Manager with Michigan Farmers Market Association (MIFMA). 

Eligible patients are screened and referred to the program, typically by a healthcare provider, and patients are then issued prescriptions that can be used for fruits and vegetables at retail partners, such as farm markets or grocery stores.

“These prescriptions or ‘incentives’ usually come in the form of paper vouchers or tokens that you can use similar to the general dollar at the food partner retail site, or there are also PPR models that use Fruit and Veggie Food Boxes, which contain a set amount of produce and are distributed incrementally from a food partner site,” Pagogna says. “Many programs also include nutrition education along with the fruit and vegetables to further support healthy behavior changes.”

Equity and connection

MIFMA is a statewide, member-based, nonprofit organization that places equity at the forefront of supporting the sustainability of community-driven marketplaces to connect all consumers to local farms and businesses. MIFMA places a big emphasis on increasing food access throughout the state in an equitable manner to create meaningful impacts on Michigan’s health, community, and economy. 

“We set advocacy priorities that reflect our broad scope of work, which includes: professionalizing the role of the market manager, including providing training and technical assistance to operators of community-driven marketplaces; advancing the local food system, including promoting community-driven marketplaces across the state of Michigan; and ensuring that all Michigan residents have access to the locally grown foods available at markets, which encompasses our food access, food equity, and food assistance efforts,” shares Pagogna.

The MIFMA PPR team: Produce Prescription Manager, Bella Pagogna; MIFMA's Executive Director, Amanda Shreve; and MIFMA Programs Manager, Ashley Wenger. (MIFMA)
The first PPR program in Michigan began in 2008 in Washtenaw County. Within the past few years, there has been a significant increase in PPR programs and there are now more than 20 programs operating in Michigan. These programs work to get patients greater access to fruits and vegetables with the intention of improving their health outcomes. This, in turn, decreases their medical spending and improves interactions with the Social Determinants of Health (SDOH). 

Healthy Oakland

Laurel Dolin Stevenson, associate professor at Oakland University and technical/evaluation lead for prescription for a Healthy Oakland, launched Prescription for a Healthy Oakland in 2017 with collaborators and the Healthy Pontiac, We Can! coalition, and has been leading this initiative in Oakland County ever since. 

“I led the development and implementation of the program and I engage in ongoing evaluation and technical assistance,” Stevenson explains. “We are currently the only (and first) USDA GusNIP-funded PPR in Michigan, so this is exciting to be plugged in at the national level to share outcomes and engage in collaborative learning opportunities. My work on the Tech Rx grant has been to support PPR in Michigan — through technology advancement, shared (co)learning, and supporting the advancement of PPR through advocacy, raising awareness, and supporting policy and legislation.”

Eligible patients are screened and referred to the program, typically by a healthcare provider. (MIFMA)

Stevenson shares that her team has learned an incredible amount about developing and implementing PPR, which has allowed them to expand their work and advocacy around PPR. 

“We have gotten into the space where we are able to share lessons learned and we can see the health outcomes for those that participate in PPR (increased food security, improved physical and mental health, lower BMI and blood pressure, increase in fruit and vegetable consumption, better self-efficacy and knowledge around healthy eating) and economic impact around the implementation of PPR,” she says. “We have also dealt with challenges and have been able to advocate for some funding to fill those gaps and address those challenges of PPR implementation, such as streamlining technology around the management of PPR.”

Another area incorporating PPR models into their community is in the Upper Peninsula. Tammy Rosa, who is the nutrition program manager for the Upper Peninsula Commission for Area Progress (UPCAP), began working with produce prescription in the fall of 2020, when UPCAP participated in a regionally collaborative feasibility study funded through the Michigan Health Endowment Fund and Feeding America West Michigan. After several months of meetings, UPCAP, in partnership with several organizations, worked to identify and access funding for “Food as Medicine” programming throughout the Upper Peninsula. In June of 2021, UPCAP received grant funding from the Superior Health Foundation of Marquette County to develop and implement the “U.P. Food as Medicine Program.” 

“This has been a highly collaborative program, working closely with partner organizations like the Marquette Food Co-Op, Upper Peninsula Health Plan (UPHP), Lions of Michigan, Public Policy Associates, and MSU Extension, that assisted with the development and implementation of the program regionwide,” explains Rosa.

Areas of concern

Two areas of particular concern in the Upper Peninsula (and across the state) are the level of food insecurity and the level of chronic health conditions of local residents. 

“Implementing produce prescription programming not only helps to increase food access but also contributes to the prevention of chronic health conditions associated with a higher intake of fruits and vegetables,” says Rosa. “Each participant enrolled in our program receives $15/week for 20 weeks ($300) to purchase fresh produce at local participating farm markets. In addition to improving food access, prescription for health programming can provide nutrition education for participants and economic benefits for local producers.”

UPCAP’s program started in 2022 with 156 referrals to the program and 105 enrollments. During 2023, their referrals have grown to 535 (a 243% increase)  with an enrollment of 453 (a 331% increase) and they expect these numbers to continue to grow.  

“The need for this programming is real, and sustainable PPR programs can play a key role in making a positive impact in our communities,” urges Rosa. “The need for sustainable funding is also real and key, to making this programming more accessible statewide. While grant funding is not only helpful and necessary, working with local legislators to advocate for sustainable funding options may be more impactful as a long-term solution.”

Currently, PPR programs in Michigan and across the majority of the country are individually funded with philanthropic or grant dollars, such as a mixture of state and federal grants, private foundations, and/or hospital community health benefit dollars. This means that each program is funded differently and must secure its own funding source year after year. 

“Due to these inconsistent funding sources, many programs struggle to continue past pilot years and/or need to shift programmatic design when funding sources change due to the amount of funding they can secure and restrictions with funding received,” explains Pagogna. 

But that shouldn’t be a reason to hold back on becoming involved, advocates say. 

Learn about PPR 

One way health care organizations can get involved is by reading MIFMA's Landscape Report of Produce Prescription Programs in Michigan, which gives an overview of the Produce Prescription Programs that operated between 2017-2021, including details on their partners, funders, patient eligibility, prescription incentive model and value, participating patient numbers, and links to their individual websites.

Another way is by joining MIFMA's Produce Prescription Statewide Learning Network.

“Our Statewide Learning Network is a quarterly network meeting for PPR program implementers, food partners, health care partners, funders, stakeholders, and really anyone interested in Produce Prescription,” explains Pagogna. “These meetings act as an open-forum update and learning space to generate discussion on a variety of different topics, but can include PPR best practices, new practices, partnerships, future funding opportunities, and more.”

At their core, PPR programs are built by the community for the community. 

“As I mentioned before, these programs traditionally require a partnership between a health care entity and a food retailer, which are guided by aligned values, that aim to expand the field of supporters for this intervention, highlight multidimensional impacts from a single financial investment, and advance sustainability by leveraging SDOH resources from all participating partners,” says Pagogna. 

To learn more about PPR programs or how to organize one within your community, visit MIFMA’s PPR page.

This story is part of a series that explores access, equity, and sustainability through Good Food in Michigan’s thriving food economy. This work is made possible by Michigan Good Food and is supported by the W.K. Kellogg Foundation.
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