Doctors as Farmers: How Food 'Prescriptions' Can Save Our Cities

By Michel Nischan
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Joe Erario


I was recently asked to talk about Wholesome Wave's new Fruit and Vegetable Prescription Program (FVRx) at the Roots of Change Conference in Los Angeles. We partner with Roots of Change and they throw amazing conferences, so the answer was YES!

FVRx relies health practitioners in underserved communities to serve as "dispensers" of "prescriptions" that can be redeemed for fresh fruits and vegetables at local farmers' markets. The concept is receiving tremendous excitement, but especially from the practitioners who are charged with providing health services to people who have no access to healthful food and, in most cases, no health insurance. Quite a charge—steward the health of folks who can't afford the stewarding.

As always, I wanted to be provocative and somewhat entertaining, so I looked for an angle to help everyone draw a connection between community health practitioners and farmers. The more I chewed on this, the more I realized that these two groups have a bit in common. For instance:

    • Farmers passionately steward the health of the soil. Practitioners passionately steward the heath of the community. Neither group is "in it for the money."

    • Both work long hours in conditions most workers would never accept.

    • Both feel a tremendous sense of accomplishment when they succeed.

They face the same challenges:

    • Both are seriously underfunded,

    • Both know what they need to do to provide maximum health to their charges, but lack even the non-financial resources to do so.

    • Both feel that good food is key to a vibrant and healthful life.

I have no idea how it came to me, but I came up with a one-word-notion approach to make the connection obvious, and dubbed the physicians in underserved communities the new American "PHarmers." I thought, "Man, this is kitschy." But the team said, "Works for us!" Therefore, I introduced the notion that because we are giving these noble folks the ability to provide the food their patients so desperately need to make the lifestyle change that can prevent expensive diseases, "PHarmers" seems appropriate.

NEWSFLASH! The choice for an underserved community member isn't between a chicken and vegetable dinner and a Happy Meal.

After all, it's all about the food when it comes to diet-related, preventable health conditions that cost American taxpayers over $800 billion annually.

Seems like common sense: Shift money from expensive treatments toward the food that the folks who suffer from obesity-related disease need in order to become, well, un-obese. The money also creates economic stimulus and jobs instead of record profits and dividends for very few people on the treatment side.

At this point in preparing, I realized that I had to deal with the serious misinformation and misperception that exists in the minds of many Americans, because their votes drive policy and, frankly, hatred. Many Americans believe they know why obesity is so rampant, but they truly don't.

Lots of people in the sustainable food movement know why underserved community members are in the condition they are in—because we work there. Besides, some of the folks I'm addressing happen to be relatives and friends of mine.

What Many Think

Underserved community members (often referred to as "those people," or "they"):

    • Are lazy and should get a job

    • Don't know how to cook

    • Don't want good food; they want junk

Unfortunately, much of this misperception comes from widely published information created by folks who usually agree with the sustainable food movement. I looked hard at the following two popular statements and felt they need adjustment:

    • Rising rates of obesity in children and adults stems from poor food choices.

    • The vast majority of obese children and adults live in food deserts with no access to healthful food.

Bullet number one implies that given the choice between good and bad food, community members will make a "poor choice." This has been proven flat wrong, because most of these children and adults live in places where they can buy food only from a liquor store, gas station, or convenience store—none of which offer healthful foods.

They have no choice.

Bullet number two is interesting in that it debunks bullet number one, but then does not paint an accurate picture. While most folks in these communities do live in food deserts, many live in "shifting sands" neighborhoods—places where they can actually get to a grocery store. When they do, they find the only food they can afford is the carb-laden, highly processed stuff available at the liquor store near home.

NEWSFLASH! The choice for an underserved community member isn't between a chicken and vegetable dinner and a Happy Meal. It's between a $2.00 head of cauliflower and a $1.69 four-pack of instant noodles.

We've boxed health practitioners into narrow roles as educators and evaluators, rather than allowing them to be powerful dispensers of the missing resources.

What We Know at Wholesome Wave

It's not about laziness, addiction, lack of cooking skills, or sugar soda. Affordability is the key issue, and, if it is left unaddressed, large supermarkets, unable to resist millions in new tax credits, will be put in the position of opening and then having to close when tax benefits wear off. They have fled before, and they will flee again if affordability isn't addressed.

So, here's the real deal in these neighborhoods: An obese guy goes to the community health center. The doc advises him to eat more fruits and veggies and to exercise. The guy looks at his food budget and decides he can't afford better food. Exercise only makes him hungrier and the food he can afford keeps him fat. He gives up and eventually gets sick. He goes back to the doc and is diagnosed with type-2 diabetes. The doc prescribes a brand-name diabetes drug because the producer of the drug sees value in providing it to people who lack health insurance—no generic drugs here. And why not? The company gets reimbursed under the traditional health care legislation by some of good chunk of that $800 billion. What a great business plan! I'd love to give away food to my customers and get paid by the government. I wouldn't have an empty seat in the house! No wonder some folks didn't want health care reform.

Imagine this: Same guy goes to the doc and gets the same advice, accompanied by a FVRx prescription to buy enough fruits and vegetables to significantly increase his consumption—way cheaper than medication. The guy buys his fruits and vegetables, goes home, exercises, gets really hungry, and eats his fruits and veggies, which are more filling and way less caloric than a processed noodle meal. He loses weight, doesn't contract diabetes, and doesn't burden the system.

Until now we've boxed health practitioners into narrow roles as educators and evaluators, rather than allowing them to be powerful dispensers of the missing resources their patients so desperately need. Happily, early results from our FVRx pilots are showing that when folks who can't afford to make good food choices are provided with affordability, they happily make the right choice.

We completely dig this idea of American PHarmers being able to offer both good advice and the good food to back it up. We see how this can clearly provide a new formula for American health.

Farmer + PHarmer = a healthier America.

This article available online at:

http://www.theatlantic.com/health/archive/2010/10/doctors-as-farmers-how-food-prescriptions-can-save-our-cities/64331/