Doctor prescription for healthy food?

Potatoes are weighed during a CSA pickup at Zenger Farms. (Portland Tribune/Jonathan House)
Potatoes are weighed during a CSA pickup at Zenger Farms. (Portland Tribune/Jonathan House)

PORTLAND, Ore. (The Tribune) — We all know that eating more fruits and vegetables leads to better health. But what if your doctor could actually write a prescription for healthier food?

Zenger Farm, in partnership with Multnomah County Health Department and the National College of Natural Medicine, is taking the first step toward that dream with a pilot program to offer what they are calling Prescription Community-Supported Agriculture (CSA).

“I would rather see health care in the grocery store than in the pharmacy,” says the Southeast Portland urban farm’s Program Director David Perry.

Many of the details of the program are being worked out, but by next June around 40 patients will begin receiving their share of produce from local farms. The weekly harvest varies with the season and with the farm, but Zenger Farm’s shares aim to feed a family of four, so the patients’ families will see benefits too.

“It’s a new way to hear about a CSA and that it is achievable financially,” Perry says, adding that his boxes, which include recipes and donated grains from Bob’s Red Mill, cost $27 per week, with some scholarships available.

Perry jokingly calls CSA shares the original form of crowdfunding, a business model made popular by Kickstarter. Instead of using bank loans to fund initial annual costs, for the past 25 years some small farmers have invited the community to buy a “share” of their harvests at the beginning of the year. Then customers pick up boxes of the bounty each week, either at the farm or at farmers markets.

If Zenger’s program works, people could be picking up their apple a day at the doctor’s office.

Farm has seen success

It feels good to be out on the farm.

The people trickling out of their cars on a recent October morning at Zenger Farm take deep breaths of the chilly air and lock their eyes on bright red peppers, dark green acorn squash and blushing yellow carrots. They are here to pick up their share of vegetables and fruits.

Sisters Ruth Graham and Suzette Brouillard of the Cully neighborhood in northeast Portland make the trek out to this urban farm on Southeast Foster Road each week from June to mid-November to pick up their share of the farm’s weekly harvest. The sisters feel grateful to be part of a 3-year-old program that allows them to spend their Supplemental Nutrition Assistance Program (SNAP) dollars on the share. Thanks to a scholarship, just $20 buys them several pounds of local, organic produce each week.

Zenger Farms intern Justin Moran shows off a parsnip Elah Peterson during a CSA pick up. (Portland Tribune/Jonathan House)
Zenger Farms intern Justin Moran shows off a parsnip Elah Peterson during a CSA pick up. (Portland Tribune/Jonathan House)

“We are eating a lot more fruits and vegetables,” Graham says, adding that she and her sister have both lost weight during the summer. “My doctor’s happy with our cholesterol.”

It’s that kind of feedback that led Zenger Farm’s Assistant Farm Manager Bryan Allan to wonder if access to their CSA could be expanded into a sort of doctor-prescribed service for people struggling with diabetes, heart disease and other ailments known to be associated with poor diets.

“In general, people’s comments are about their health,” Allan says of CSA participants.

As part of a larger grant from the Oregon Department of Agriculture, the farm will begin to sign people up beginning in June 2015. Doctors at each health institution will select a group of 20 patients to “prescribe” a CSA share in the hopes that it will improve their health. Patients will still have to pay for the food themselves and pick it up each week, but organizers are hoping that the official guidance will help turn thoughts to action.

“A prescription is really just an authority giving you a recommendation,” Allan says, noting that a suggestion in a health center feels different than one at a grocery store. “It’s all of these intangible aspects that hopefully will have the impact we are hoping for.”

Could food prescriptions work?

Internist Dr. Craig McDougall agrees that the place where most Americans learn about food choices from is far from ideal.

“People get their information from industries that are trying to sell you their products,” McDougall says.

He is the lead physician of Kaiser Permanente’s Healthy Living Program, a lifestyle medicine clinic, which is not part of the pilot program. But McDougall says it could make a dramatic impact in participants’ health.

“I’ve never made anybody well by giving them more pills,” he says. “And you never will, because that’s not the underlying problem. The problem is not that they didn’t have a pill in their life. The problem is that they were not having the right lifestyle.”

But while health insurance companies pay billions for medicine each year, Pacific University Assistant Dean of Pharmacy Michael Millard, RPh, says he would be surprised if they were ever willing to start paying for food.

“You can see that food is sort of a slippery slope. You start buying everybody food and then that really is going to make health insurance expensive,” Millard says.

Program Director David Perry says he is a bit more optimistic after Zenger Farm’s success with the program to use SNAP for CSAs. Now, with the Affordable Care Act and coordinated-care organizations giving companies more latitude in their approaches to health care, Perry says they see an opening.

“What the health care industry is really excited about is with the Affordable Care Act, the payment model is shifting from paying for treatments to paying for outcomes,” Perry says. “We have to be able to demonstrate the success of it, which is no easy task, but that’s what we’re diving into.”

Multnomah County Health Department will track the health of its participants from Mid County Health Center on Southeast Division.

That said, health care is not truly the goal of this particular program. Funded by the Oregon Department of Agriculture, the project’s primary aim is to find new customers for local farms.

“What ODA is most interested in is increasing sales for farmers,” Perry says.

Blazing a trail

The full two-year, $68,392 ODA grant will fund a training program and toolkit for five vegetable farms who want to partner with institutions, such as large businesses, churches, or fitness centers, to offer their CSA programs. Employees, congregants or gym members will be able to pick up their share from a place they already go, instead of having to make a separate trip to the farm or farmers market.

Perry says farming is such a low-margin industry that farmers can’t afford to spend a lot of time figuring out the logistics of a new customer base. Zenger and the other four farms in the pilot project aim to work out a roadmap for other farms to follow.

Dr. Courtney Jackson is the co-founder and lead physician of NCNM’s new Food as Medicine Institute and is excited about the possibilities. NCNM has partnered with Zenger before and was quick to sign on to this new project.

“It’s going to be a little bit of trail-blazing of seeing how the logistics play out and how the patients react when they are offered an opportunity to participate in a CSA,” Jackson says.

Sami Jarrah, deputy director for Integrated Clinical Services at Multnomah County Health, says access to healthy foods has always been a goal for their community health clinics.

“This actually goes to the roots of community health centers,” Jarrah says. “And health reforms give us a little more flexibility to do things like this that fall outside of a typical health center visit.”

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