The cheapest foods tend to be calorie-dense but nutritionally bankrupt—think of the bounty a five-spot furnishes from the McDonald’s dollar menu.
And when straight-up access to nutritious foods is obstructed or barred to many Americans—most often those in communities of color, low-income neighborhoods, and rural areas—swinging by the drive-thru often makes the most sense. Not everyone has the luxury of a few hours to browse farmers markets and roast, chop, and blanch a mountain of fresh vegetables for the week ahead, or the space to store them.
But consuming foods low in nutrition deprives the body of critical vitamins and minerals and increases the risk of developing serious illnesses like diabetes, hypertension, and heart disease. Treating or managing those conditions isn’t cheap. How do we even begin to chip away at a tangled network that pushes fast-food franchises into urban communities of color and creates a market of cheap and filling foods that doesn’t support health?
Enter Fruit and Veggie Rx boxes.
“Fruit and Veggie Rx boxes—they’re actually not just healing people and families, they’re healing whole systems,” says Pakou Hang, co-founder and director of Hmong American Farmers Association (HAFA).
The goal of Fruit and Veggie Rx boxes—a program run by HAFA and HealthEast Clinic-Roselawn—is getting CSA boxes of healthy fruits and vegetables into the hands of people who live in food-insecure areas. Jump-started by a grant from Blue Cross Blue Shield, Fruit and Veggie Rx offers seasonal, culturally relevant CSA boxes to participants who have been referred by HealthEast doctors. Produce is drawn from crops grown by farmers in HAFA, so contents may include Hmong cucumbers, bitter melons, ground cherries, and Korean yellow jewel melon, in addition to what Hang describes as more mainstream produce (tomatoes, basil, onions, celery).
The produce goes a long way to providing patients with essential nutrients. But Hang and her partners think holistically. They see the boxes as just one spoke in the wheel of the food system, which, to her eyes, is pretty broken.
“Yes, it’s about giving people access to healthy food,” she says. “It’s also about how we build community. How we care for each other.”
As Fruit and Veggie Rx was being developed, Hang and her partners decided to focus on St. Paul’s east side to have as much impact as possible, both in increasing access to nutritious foods and fostering community. The area experiences low rates of health insurance, a low employment rate, and a high rate of poverty. Many families are food-insecure or are political refugees or recent immigrants.
Since its pilot year three years ago with HealthEast Clinic-Roselawn and a few participating families, Fruit and Veggie Rx is now available in four clinic locations and serves 100 families.
Dr. James Letts, who’s been involved with the program since its inception, reports that patients have seen positive health indicators, like improved control of diabetes. What surprised him were “the unexpected social and mental health benefits of the program.” He’s seen a patient for over a year who struggles with debilitating illness, both physical and mental, for whom the usual treatments didn’t lead to much success. “He was enrolled in the Fruit and Veggie Rx program,” Letts says, “and literally the first time I ever saw him smile was when he left the clinic carrying a big bag of colorful veggies for him and his family.”
Hang, doctors, and staffers at program sites have seen other positive results these past few years. Not only were patients and their families excited for clinic visits, but staff were also more engaged. “There was so much more social capital,” Hang says. “It’s not just a box of food. It’s like offering them a relationship or a friendship, and you’re showing: ‘I care about you.’ It changed everything.”
Fruit and Veggie Rx isn’t the only program of its type. Wholesome Wave, an organization based in Bridgeport, Connecticut, has several initiatives aimed at increasing fruit and vegetable consumption in food-insecure individuals and families. Letts applauds WW’s positive health outcomes, but adds that Fruit and Veggie Rx is unique in “its simplicity for patients.” Physicians and clinic team members easily enroll new folks in the program for free, and they pick up their CSA boxes right there at the clinic.
“Perhaps the most unique aspect of the program,” Letts says, “is the associated community-building that HAFA has been leading.”
He’s referring to the annual celebration HAFA hosts for patients and families, clinic staff, HAFA staff, and HAFA farmers. Everyone takes a bus to the farm for a tour, before enjoying a big dinner together.
“People should eat together,” Hang says. “In many indigenous cultures and many cultures in general, they sit down and they create space for food, for meals. Mealtime is when families reconnect, when communities connect, and they take their time with the food. It’s not just about the content of the food, but it’s about what is done during the meal.”
Hang notes that our society doesn’t “teach people how to cook real food anymore,” and she heard of program participants asking neighbors for advice. She learned that two families had lived next door to each other without talking for 15 years, but when one encountered an unfamiliar ingredient, they knocked on their neighbors’ door. (For those who prefer reading to door-knocking, HAFA has also added newsletters, recipes, and examples to CSA boxes.)
So far, Fruit and Veggie Rx has been funded through grants, but Hang and her partners are exploring how to make the program sustainable on its own. “If we have health insurance companies that are willing to subsidize gym memberships, couldn’t they subsidize Veggie Rx boxes?” Hang asks. Again, she’s thinking of the long game: A little subsidization of healthy food now prevents costly suffering later.
What’s next? If Fruit and Veggie Rx can operate independently and continue to flourish, how does the program fit into modern American healthcare? And our food system? While the program on its own can’t entirely fix these giant systems, Fruit and Veggie Rx does provide a window into a possible future. There, food and medicine aren’t siloed. Healthcare supports whole health. Patients develop meaningful relationships with their care providers and with other members of their community.
“Food is a great uniter,” Hang says. “Yes, there are a lot of divisions and tensions in the world right now, but there are also people who care about each other, and people who want to heal and lift each other up. We have to remember that.”