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Building Capacity for Healthy Food Prescriptions

North Carolina is fertile ground for an approach that bolsters health care’s role in addressing food security and opens doors to healthy food, all while leveraging the expertise and leadership of two of the state’s great resources - its people and the work of our community-based organizations.

This promising approach - Healthy Food Prescription Programs - features partnerships between community-based organizations and the health care sector that leverage the inextricable links between food, nutrition, and health. In these programs, health care providers assess patients for diet-related conditions and/or food insecurity. They then prescribe a food-based intervention, delivered by local organizations with long-standing ties within their community, and in many cases, local producers.

Like many medications, Healthy Food Prescriptions are not a cure all. However, they are many great things, including most significantly a pathway to food security, nutrition, and health. They meet people where they are. And they leverage, and marry, the expertise and trust of health care providers with the capabilities and wrap-around services of community organizations to serve the unique needs of residents.

In an era of deepening focus on shifts to value-based care and increased attention on non-medical drivers of health, growing Healthy Food Prescription Programs could not be timelier, both in North Carolina and throughout the country. With them, the health care sector and others have an emerging opportunity to meaningfully move the dial on addressing food security and reducing diet-related conditions.

Understanding this potential, our foundation funded a statewide scan of Healthy Food Prescription interventions to learn more. From this, we saw the opportunity to strengthen the Food is Medicine work happening in our state, which resulted in a three-year $4.5 million investment to support, and learn from, 10 Healthy Food Prescription Programs throughout North Carolina that were identified as part of this scan. They range from small operations serving historically under-resourced neighborhoods to the largest produce prescription program in the country, whose footprint spans the entire state.

Collectively, these programs showcase the gambit of possibilities within Healthy Food Prescriptions, including:

  • Solutions for urban, rural, and Tribal communities.
  • An array of interventions ranging from vouchers and medically tailored meals to fresh food from local farms.
  • Diverse health care partnerships including health plans, health systems, community health centers, and more.

Each organization – detailed below – is receiving $300,000 of funding over two years and are participating as part of a learning community to engage with, and learn from, one another.

Appalachian Sustainable Agriculture Project (ASAP): The “Farm Fresh Produce Prescription” (FFPP) program provides wraparound support and weekly financial incentives for fresh, local fruits and vegetables from farmers markets and food boxes from farms. Mountain Area Health Education Center (MAHEC) is the primary health care partner, along with other smaller clinics, urgent care facilities, and other care managers. Eligible patients include western North Carolina residents who have, or are at risk, of developing a diet related disease or are eligible for a federal nutrition program like SNAP. The organization serves western North Carolina counties.

Conetoe Family Life Center, Inc.: Through their partnership with ECU Health Medical Center, they are providing increased awareness on how to treat and manage chronic health conditions with medical nutrition therapy. In a holistic approach, they supply customized food boxes from their farm through community-based stakeholders with wraparound health and wellness information and support, including garden boxes and plants. The organization serves Edgecombe County.

Feast Down East (FDE): Through a partnership with Novant Health, Feast Down East will fulfill healthy food Rx vouchers at their Local Motive Mobile Farmers’ Market in the Cape Fear region with seasonal foods procured from local farmers through the FDE Food Hub. Mobile Market locations include public housing communities, after school programs, community centers, and (beginning in 2023) various Novant and community health care clinics. FDE is also participating as a subcontractor for food in the Medicaid Healthy Opportunities Pilot with Community Care of the Lower Cape Fear. This organization is serving Pender, New Hanover, and Brunswick counties.

Green Rural Redevelopment Organization (GRRO): Green Rural Redevelopment Organization supports healthy food boxes, medically tailored meals, and wraparound supports and services specifically for the Haliwa-Saponi tribal region in partnership with Twin County Rural Health Center. The organization is also a food vendor in the Medicaid Healthy Opportunities Pilot with Access East for the northeast region and serves Halifax and Warren counties.

Highland Neighborhood Association: Highland Neighborhood Association (HNA) collaborates with community partners to improve health in the neighborhood through obesity reduction while creating fresh food access. HNA supports a grab-and-go prepared community-based meal program run by RAMS (Really Amazing Meals with Soul) Kitchen in partnership with Kintegra Health and CaroMont Health. The organization serves Gaston County.

Hunger and Health Coalition: Through key partnerships with both the local health care system and local farm system, Hunger and Health Coalition provides services that include medically tailored healthy food boxes, nutrition education, and mobile delivery to vulnerable populations in northwest North Carolina. The organization is also a vendor in the Medicaid Healthy Opportunities Pilot with Impact Health, and serves Watauga County.

Loaves and Fishes Friendship Trays: Loaves & Fishes Friendship Trays provides healthy food boxes to individuals with a chronic illness and are identified as food insecure. Current partnerships with health care providers, such as hospitals and community clinics, are the main referral systems to help connect individuals to their services. Individuals receive seven days’ worth of nutritionally balanced and healthy non-perishable and perishable items. The organization serves Mecklenburg County.

Reinvestment Partners: Reinvestment Partners leverages technology to provide $40 per month to participants who then purchase fruits and vegetables of their choosing at major retailers. The program started in 2018 and has received $30M in public and private funding and enrollment partnerships with commercial insurers, health care systems, care management companies, and Federally Qualified Health Centers. As a result, the program has grown to serve more than 50,000 North Carolinians in all 100 counties.

SHARE Winston-Salem, Inc.: SHARE Winston Salem provides medically tailored food boxes in partnership with United Health Centers and the Wake Forest School of Medicine. The United Health Centers screens for eligible candidates (i.e., those who are food insecure, have diet-related diseases, higher-risk pregnancy, etc.) The organization serves Forsyth County.

TRACTOR Food & Farms: TRACTOR's local food subscription program, Farefield, provides produce shares to clients and customers through partnerships with local businesses, regional health care providers, clinics, hospitals, and health and relief agencies. Local farm products are aggregated to offer a wide selection of seasonal fruits, vegetables, dairy, grain, and meats. Customers may customize weekly shares by setting preferences and/or making direct product selections. The organization serves Yancey, Mitchell, Avery, Madison, Buncombe, and Henderson counties.