Sometimes the best medicine isn’t a pill, but a vegetable. Eating healthy food is one of the most effective ways to prevent and manage many costly and debilitating conditions, and providers and health systems are realizing that they need new ways to help their patients maintain the right diet. Alameda Health System’s “Food Is Medicine” initiative uses alternative visits and other resources to make food a real part of the care they provide.
The Path to Integrative Medicine
Patients want more than a 20-minute visit. While this has always been true, the healthcare system wasn’t structured in a way that incentivized more in-depth interactions between patients and providers. In fact, it bristled with rules and policies that turned provider focus to EHR entry, care coordination, and efficiency.
However, recent advances in patient agency and choice have heightened the need for community health centers to change gears and give patients what they want and need: a more holistic experience that is about more than prescribing the right pill or performing the right surgery. Integrative medicine embraces complementary and alternative medicine practices, as well as viewing a verdant community as vital to individual health. A person’s relationship to food has a huge impact on their long term wellness and happiness, and so healthcare providers need to be a part of helping their patients eat and build good habits around food.
More than 73% of Hayward residents do not consume adequate fruits and vegetables. In seeking to be a bigger part of helping patients with nutrition and diet, the Hayward Wellness Center, part of the Alameda Health System, adopted new programing around the idea that “food is medicine.” The goal was to increase consumption of healthy food, especially fresh produce, and thus eventually improve patient health. To get there they designed group visits where patients could learn cooking skills and trained providers to help talk to patients about food. This began to build a culture of thinking as eating fresh, healthy food as just as important as prescription medicine.
A Full-Bodied Intervention
- The program at HWC began by introducing group visits for patients who have diabetes or were considered pre-diabetes. There was both an adult group (18+) and a youth group (ages 5-12), and the visits were offered in both English and Spanish.
- These group medical visits included cooking classes and nutrition education that helped support patients in learning how to plan, shop for, and prepare healthy meals and snacks on a budget. The curriculum focuses on the value of fresh produce, with a goal increasing patient self-confidence in their ability to make healthy meals using fresh produce—as well a greater understanding of the relationship between diet and health.
- The group visits also focused on increasing patients’ access to fresh produce through education about community organizations and resources, such as food banks, CalFresh, WIC, and farmers markets (where one can pay with EBT and double CalFresh benefits).
- In the second year of their effort, HWC introduced a provider education and behavior change component, which included teaching providers about the relationship between food and health and providing resources to help providers educate patients about the importance of good nutrition. This provider education included three interactive sessions, such as hands-on cooking exercises. The goal was to help providers feel more confident talking to patients about diet and incorporating different food into their lives.
- HWC developed a set of handouts targeted to both providers and patients covering conditions such as diabetes, hypertension, and IBS. These included helpful tips for managing the condition with diet and lifestyle changes, and an MI type “action plan” to support goal-setting and behavior change.
- Finally in a “produce prescription” intervention, providers were given vouchers for fresh food to give to patients. Patients could then exchange the vouchers at a “farmacy” produce stand located in the HWC’s lobby of and staffed by Dig Deep Farms. Dig Deep Farms is a program of the Alameda County Sheriff’s office that employs members of the reentry population to grow and sell fresh produce on unused/unincorporated land. Vouchers purchased the equivalent of $10 of fresh produce.
Resources for Behavior
HWC created a series of handouts on using food to treat and prevent chronic health conditions:
HWC had good success with their program, increasing the confidence of their providers in recommending food as medicine, as well as the confidence and motivation of their patients to prepare vegetables and adopt healthy eating habits. They saw a 74% redemption of produce prescriptions. The program is continuing but funding for the produce bags is limited.