Should Healthcare Companies Pay for Groceries?

“Food-as-medicine” programs are popping up across the U.S. in an effort to address the intertwined issues of health, poverty, and food insecurity. Proper nutrition is vital to good health, and all too often, healthy foods are recommended yet rarely distributed under the healthcare umbrella. Given the prevalence of acute food insecurity in many communities across America, farmers and doctors alike are advocating for change.  

According to the National Institutes of Health, food insecurity (defined as lack of access to affordable nutritious food) is associated with increased risk for multiple chronic health conditions, such as diabetes, obesity, heart disease, and mental health disorders. The combination of food insecurity and chronic health conditions disproportionately affects racial and ethnic minority communities as well as poorer communities.

The risks are compounded for children who lack proper nutrition. For kids, mental and physical development can be impacted—as well as their experience at school. Food-as-medicine programs are taking various approaches to try and solve this risky puzzle, but there is little to no data on what works and how to implement it. 

Stanford Medicine’s Food for Health Equity Lab hopes to fill that gap. 

The lab, which received Stage 2 funding from Stanford Impact Labs, is part of a food-as-medicine pilot program focused on preventing and managing illness among patients who experience food and nutrition insecurity in Alameda County, California. The project asks what more can be done upstream—before chronic health conditions set in. In addition to investigating how food-as-medicine can benefit patients’ health, the project also set out to establish a standard data collection and evaluation protocol that other organizations can use to weigh the success and effectiveness of food-as-medicine programs. 

Recipe4Health (R4H) began as part of an effort to reduce poverty in Alameda County. It is a multi-sectoral collaboration between Alameda County, Community Health Center Network (a consortium of community health centers), Open Source Wellness (a non-profit organization), and Dig Deep Farms. The Food for Health Equity Lab’s role is focused on building partnerships and creating the structure to support the research, including managing the complex data ecosystem involved with sharing health information. The goal of R4H is to increase the health of individuals, the local economy, and the community as a whole while also establishing a template for how to run and evaluate a successful food-as-medicine program.

The program began in the Fall of 2019 and combined a produce prescription program with behavioral interventions that gave participants support for making lifestyle changes. Participants received a weekly food delivery for 16 weeks, with each delivery containing ingredients for approximately 16 meals. Participants also had the opportunity to attend weekly Zoom meetings for four months that focused on physical activity, healthy eating, social connection, and stress reduction. 

Lisa Goldman Rosas, a Stanford epidemiologist and principal investigator at the lab says, “Produce prescriptions—where a healthcare professional prescribes fruits and vegetables and health insurance covers the cost—are an excellent way to support patients who are at risk for chronic disease, or perhaps have a chronic condition they're managing. Prescribing healthy food signals to a patient that nutrition is as important as their medication. It’s less stigmatizing than food assistance programs, and it is scalable.”

While data collection will continue through next year, in April 2023, the study collaborators released a paper with preliminary results. The news is positive—there were multiple increased indicators of health as well as increased food security. The paper’s primary emphasis, however, was to share the study’s research and data collection methods as a protocol that others can use to assess effectiveness of their food-as-medicine programs.

Throughout the process, the project is keeping lines of communication open with policymakers, sharing preliminary outcomes and exploring ways that policy could help scale these kinds of programs. In February 2023, R4H hosted a policy roundtable with Health and Human Services Secretary Xavier Becerra and U.S. Congresswoman Barbara Lee. 

"We're all in on this food as medicine,” said Secretary Becerra at the event. "Today, we're challenging states to join us in treating food as medicine. And help us prove that by getting folks on good food, prescribing good food as medicine, that we're going to make people healthier."

Wei-ting Chen, project director at the lab, is always on the lookout for new partners and ways to meet this challenge. When she noticed that Instacart, the grocery delivery company, was at the White House Conference on Hunger, Nutrition, and Health, she decided to investigate. She discovered the company is investing heavily in the technological infrastructure for food-as-medicine programs, partnering with healthcare providers, and looking for additional partners to help them measure and assess outcomes. 

“There are many different models of food-as-medicine programs, and while getting produce directly from small farms may work in some locations, it won’t work everywhere. Instacart has a huge reach and they offer another way we can work toward food equity. We approached them about a collaboration, and they agreed,” said Chen.

This new pilot, which was announced as part of the White House Challenge to End Hunger and Build Healthy Communities, is a collaboration between the Stanford Cancer Institute, the Food for Health Equity Lab, and the University of California, San Francisco’s Helen Diller Family Comprehensive Cancer Center to study the impact of nutrition security interventions and food-as-medicine services on different patient groups, including individuals living with low incomes. The study will provide fresh food and whole grains to about 20 patients who have recently completed treatment for colorectal cancer.

According to Rosas, food-as-medicine programs are incredibly promising, which makes the work of collecting the data to prove efficacy particularly necessary. “We know food-as-medicine programs seem to work, but we haven’t yet systematically identified what makes a program successful and effective. Our qualitative work with Alameda County and Instacart and all the partners involved in each project are giving us the opportunity we need to determine how we can affect the greatest improvements in health equity.”

Open Question is a forum for commentary about social problems and methods of tackling them in the drive for progress.