'Prescribing' veggies for holistic health care

"Take two zucchini and call me next week." Imagine if that was how your doctor ended your last physical. New vegetable prescription programs could make this a reality.

Sometimes called Veggie Rx, or Prescriptions for Health, these programs have the potential to reduce spending on medicine and encourage meaningful connections between patients and local farmers and smaller-scale gardeners – not to mention improving people's health through better diets that are also more affordable. Veggie Rx reimagines the conventional relationship among patients, healthcare providers, and food providers.

Veggie Rx programs have sprouted up throughout urban and rural America. They can take many different forms (see Wholesome Wave and Norwich, Conn.) but the common thread is providers writing prescription vouchers that they can use to buy produce, often at local farmers markets. Physicians at St. Christopher's Hospital for Children have been writing the scripts for several years in the North Philadelphia hospital's Farm to Families program. Doctors hope they will encourage increased consumption of fresh fruits and vegetables. Some patients, particularly in low-income communities, may be more used to getting prescriptions for medicine than buying fresh produce, which can be hard to find and pricier than less-healthy foods. Filling these new kinds of prescriptions gives them a hand in improving their own health and well being. Writing them gives physicians another way to present the old you-need-to-eat-better advice.

More than two-thirds of Americans are overweight or obese, raising their risk for cardiovascular and other chronic diseases. (Use this calculator to determine where you stand.)  Philadelphia, with the highest poverty rates – a risk factor for obesity – of the nation's 10 biggest cities, faces more challenges than most. While individual choice plays a large part in people's diets, the availability, affordability, and freshness of produce – who wants wilted lettuce? –  all play a role.

In the West Philadelphia census tract surrounding Sayre High School, 80% of the population is overweight or obese. If you walk by the school, at 58^th and Walnut, you might not guess that there is a courtyard garden nestled inside. The garden, run by Miki Palchick and Sierra Harland, and staffed by high school interns, grows vegetables for Good Food Bags, a low-cost, urban, community supported agriculture program. It is run in a partnership between the Agatston-Urban Nutrition Initiative, a program of the Netter Center for Community Partnerships at the University of Pennsylvania, and the Sayre Health Center, which is rare medical clinic housed within a high school. Good Food Bags was founded in 2012 in an effort to draw people into the garden and promote patient education. It's a small program, with 12 members and a waiting list.

While many members found it through word of mouth, some got there through a "prescription" for Good Food Bags by their physician at the health center. Unlike typical   community supported agriculture programs, which often require a hefty subscription fee at the beginning of the season, Good Food Bags asks participants to pay $25 a month. Every Wednesday, the members, mostly female retirees, trickle into the garden to pick up five pound bags of produce (though the bags often weigh in a few pounds heavier) just harvested by high school students.

Why are Veggie Rx programs a good thing? Hospitals and doctors' offices tend to treat people's symptoms, Palchick explains, rather than address the underlying reasons for poor health. And Americans, especially in urban areas, are no longer connected to the land. They are cooking less, too. Good Food Bags encourages a holistic approach to battling the chronic, diet-related diseases that most of its members are dealing with.  Here, obtaining food is more than a financial transaction, even a free one. Members are farm partners. Palchick encourages feedback to ensure the garden is growing food that its members want to cook (there are cooking classes, too).

"Chard doesn't solely improve diabetes but personal ownership of health outcomes does give patients the chance to see success," said Kiasha Huling, an associate director of the Sayre Health Center who helped start the program. "You may still have diabetes but with nutritional changes you can improve your 'numbers'–  blood pressure, weight, lipids – which makes you healthier and makes any chronic illness more manageable."

Patients rely on professionals to support their health, she said, but Good Food Bags allows them to "own their participation in fitness and nutrition, [which] is empowering and encouraging."

Zoe Blickenderfer is a senior in the University of Pennsylvania's Urban Studies program. She works part time –  as a work-study job –  at  Bartram's Community Farm and Food Resource Center, another program of the Agatston Urban Nutrition Initiative. The community farm supplies some of the produce for Good Food Bags.

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