Just What the Doctor Ordered, Food as Medicine

Fresh pomegranates on display. (Oli Scarff/Getty Images)

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If you get sick or are diagnosed with a disease, your physician will often write you a prescription for medication. But what if kale and carrots were also part of your treatment plan?

For low-income patients, who are disproportionately burdened by food insecurity, such an approach can be life-changing. According to a 2018 report from the San Francisco Food Security Task Force, about 227,000 San Franciscans, or 1 in 4, live below the federal poverty line and are at risk of food insecurity, meaning they lack access to affordable, healthy food. They also face higher rates of diet-related diseases and chronic health conditions, including hypertension, high cholesterol, and diabetes.

Tackling health disparities with a holistic approach, the Food as Medicine Collaborative was formed to bring food security to patients in need of healing and nourishment. Partnering with health clinics, food banks and pantries, and the private sector, the Collaborative’s “food pharmacies” help bridge the divide between healthcare systems and food services, transforming the eating habits of low-income patients and helping them feel empowered to take their health into their own hands. The Collaborative also drives systems and policy change, advocating for initiatives such as expanding food and nutritional services through the CalAIM Medicaid Waiver, which can improve health outcomes and reduce healthcare costs.

We spoke with Dr. Rita Nguyen, an assistant health officer at the San Francisco Department of Public Health and one of the founders of the Collaborative, to learn more about this revolutionary approach to food as medicine.

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How did the Food as Medicine Collaborative get started, and what are some of the issues you’re working on?

Many different organizations have decided to collaborate overtime because we increasingly recognized that food insecurity is an issue that needs to be tackled by healthcare, and that it is something that nonprofits and communities can’t do alone. Hunger and food insecurity aren’t just moral issues but should be recognized as health issues. The collaborative seeks to support healthcare systems to address food insecurity and nutritional health for patients and communities. We bring all the players together at the table so that these siloed areas of the food and health sectors really work together to advance the health of communities. On a programmatic level, what we’re most visible for is our food pharmacies. However, it’s also part of a bigger vision of bringing these two sectors together where healthcare can engage around food and prescribing food as medicine.

What’s a food pharmacy, and how is it different from normal pharmacies?

A food pharmacy is an intensive model that focuses on access, education skills, tools, and referrals. It isn’t just about having food in healthcare but pairing it with effective nutrition education. We believe that food is core to health and chronic disease management. We have on-site registered dieticians that help with nutrition education, while also offering quick cooking demonstrations. But having fresh food by itself isn’t enough to be able to eat. That’s why we have this cohesive and comprehensive model, where if you have food education and cooking skills, you’ll be able to cook delicious healthy meals. We also offer pantry staples such as spices, olive oil, and crock pots for those who don’t have access to stoves, and referrals to help connect them to the food safety net.

We’re not saying that healthcare should replace grocery stores. It’s really about leveraging what healthcare can offer, which is why food pharmacies are important to help solve food insecurity and bridge that connection between food and health. If you ever come by our food pharmacies, there are stations for every one of those elements, including healthcare practitioners who can check blood sugar or pressure levels, and then feed the patients with fresh food. We often hear from our patients that having that connection to food helps them feel the changes they’re making in their health because of the feedback they’re receiving every week.

Healthy eating can often have a negative connotation, including the perception of restrictive eating. Can you speak about the Collaborative’s “food as medicine” approach to transform eating habits?

It can be negative to restrict patients to certain foods, which is not what we aim to do at all. We bring tools, curricula, and frameworks into the healthcare space to help us message this differently to patients, where food can be a source of joy and not a message of restriction. We actually bring in many food-related nonprofits to do cooking demonstrations because the clinical model isn’t always the most effective way to communicate about nutrition. I think that’s another way to bring these two sectors together, learn from each other, and create more impact on patients’ lives. Even though we’re “prescribing” food, we also don’t want our patients and community members to have the impression that you need a highly tailored diet to live well. Part of the messaging too is that everything in our food pharmacies is for you.

How do farmers markets and fresh, local produce fit in? Do you integrate with any nutrition assistance or incentive programs?

Patients either get referred or a written prescription for the food pharmacies, which are actually set up similarly to a farmers market, though everything (mostly fruits and veggies) is actually free for patients, so there’s no money being exchanged. But we do offer ways for patients to sign up for CalFresh, so they can use those benefits elsewhere. Income inequality in San Francisco is probably one of the biggest barriers to accessing healthy food, which is why we want to find many ways to make it possible for patients to eat well without worrying about the cost.

What are some ways people can support these programs?

Everything we do is possible through collaborative partnership. For example, healthcare systems provide a ton of in-kind staff to make this possible, and food banks and businesses provide in-kind food donations. Everyone brings something to the table. So, for anyone who wants to bring something to our food pharmacies, such as cooking workshops or letting communities know about a program, we always welcome it. It’s a space for patients to feel empowered to heal themselves rather than just being recipients of medical care in the system. We’re happy to take volunteers to help us further our mission, but we’re also open to helping people with starting their own programs. Bringing food pharmacies to clinics may not entirely close the food insecurity gap for patients, but I do think they have a role in bringing in programs to create this intersection between food and health. We can’t do this work alone.

Learn more about the Food as Medicine Collaborative. This blog post is part of a series inspired by The Food Change, a public art project by CUESA, featuring farmers, advocates, and everyday people who are making a positive change in our food system. Learn more.

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Photos courtesy of the Food as Medicine Collaborative.

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