Tag Archive | community health centers

inventive incentive

To make bread or give love, to dig in the earth, to feed an animal or cook for a stranger—these activities require no extensive commentary, no lucid theology. All they require is someone willing to bend, reach, chop, stir. Most of these tasks are so full of pleasure that there is no need to complicate things by calling them holy. And yet these are the same activities that change lives, sometimes all at once and sometimes more slowly, the way dripping water changes stone. In a world where faith is often construed as a way of thinking, bodily practices remind the willing that faith is a way of life. Barbara Brown Taylor ~ (An Altar in the World: A Geography of Faith)

On a cloudy and dreary Saturday morning in October, I headed into Albany to catch up with the ever-busy Veggie Mobile in order to get a glimpse of the Veggie Rx Program in action. It had been almost two years since I began administering this program that I had helped establish at the Health Center, and as a concerned mom, it was time for a periodic check-up to see how it was doing. 

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Capital Roots Veggie Mobile

                           

Veggie Rx is a “produce prescription incentive” wherein fruits and vegetables are “prescribed” to medically high-risk patients by their health care providers as a means to encourage healthier diets and to improve health outcomes. Similar programs have begun to emerge in the past few years, and are being considered as a model of a viable public health intervention for disenfranchised communities. This medically-housed approach provides powerful messaging, unique for an institution that traditionally proffers mainly pharmaceutical solutions and well-meaning but often weak recommendations for health behavior change. It affirms, “Let food be thy medicine.” 

Veggie Rx was initiated as a collaboration between Capital District Community Gardens (CDCG) (now known as Capital Roots) and the Whitney Young Health Center and is funded by the NYS Department of Health’s Hunger Prevention and Nutrition Assistance Program. It was designed as a pilot to serve fifty persons with diabetes and/or hypertension. Once recruited and enrolled, the participants receive “prescription coupons” valued at $7 each, which can be redeemed once per week on CDCG’s Veggie Mobile. They also receive an additional food bag valued at $4 provided as part of the Veggie Mobile’s Taste and Take tasting program each time they shop.

The bio-diesel fueled, hip-hop pulsing, “produce aisle on wheels” Veggie Mobile which I chatted about in No Passing, toodles around many Capital District neighborhoods most days of the week, year-round. It irrigates identified food deserts by arriving at a variety of community locations where anyone can shop, right on the truck. It is somewhat akin to an ice cream truck except that it hawks an impressive array of fresh fruits and vegetables, much of it from local farms. 

I met up with the Veggie Mobile that day in the city’s Arbor Hill neighborhood. Parked at the corner of a side street, it was a burst of color in a rather gray landscape. That brightly painted truck always shows up representing the rainbow, but it is the activity that it fosters that is the pot of gold. Among the customers were two Veggie Rx participants. One was a woman whom I had just enrolled in the program. She was there with her two young granddaughters. ‘Patient with diabetes’ instantly transformed into ‘loving grandma’ as I watched her solicit the girls’ advice for what to choose.

The other was a gentleman who had been enrolled for a while but who had not really participated. I had recently called him to discuss removing him from the program—but he asked for another chance. He explained that he had experienced a host of health problems but was feeling better and really wanted to have this opportunity to improve his diet. Sure enough, there he was like a kid in a candy shop–but instead of candy, he was purchasing a sophisticated assortment of produce.

After an hour at that location, the dedicated Veggie Mobile staff women closed up shop. I hopped in my car and followed them as they got back on and off the highway and made their way over to the next scheduled stop at a low-income housing complex—not too far from the Governor’s Mansion. Arriving there, about fifteen people were already waiting–men, women, and children–including two more Veggie Rx participants. They were surprised to see me and greeted me with smiles and hugs.

This was a busy site, so I assisted with bagging while anchoring myself at a good vantage point. Shopping on the Veggie Mobile begs some patience—but perhaps not any more than waiting in a fast-food drive-thru line. Here though, was connection, community and lots of conversation about good food. There was squeezing back and forth as people reached to add another sweet potato, banana or onion to their order. All forms of “monetary green” (cash, SNAP EBT cards, New York State Fresh Connect, and Farmer’s Market Coupons–along with the cute Veggie Rx coupons) were exchanged for “nutritional green” (collards, kale, green beans, green peppers, and broccoli). It was a beautiful sight to behold.

Despite my sheer love of this program, I am still not sure yet if these incentive initiatives are token, feel-good, short-term experiments–or the templates for a new health and food revolution. Are they worth the effort for the few that they serve? Can they put even the tiniest dent in the massive problem they are trying to solve and might a few fruits and vegetables a week really affect change?

What I  do know is that I have seen Veggie Rx change the behaviors and well-being of many of those in the program. Let me strengthen that. I have witnessed some profound changes. There has definitely been some powerful “medicine” going down. Participants have started juicing, making smoothies, and taken to more plant-based diets. Many have attested to feeling better and have noticeably become more enlivened. While I have also noted improvements in individuals’ health markers (weight, blood pressure, hemoglobin A1c)–to see these markers shift in a significant way for this highly challenged population will take time. I caution not to base the success of these types of programs solely on those indicators–it is too myopic a lens.

Veggie Rx offers more than just food access and is about something greater than fruit and vegetable intake. Relationship building is the true foundation of this program. This power of relationship–between participants and the Health Center and Veggie Mobile staff–is not to be underestimated. Having undertaken an evaluation of this program and through my direct contact with the participants, I know that they feel better valued as both patients and consumers which increases their engagement in both roles. I also know that they consider this program to be a blessing in their lives–those are their words, not mine.

Participation comes with some requirements which asks something deeper of its recipients–like standing out on street corners in the cold, shopping in cramped quarters, finding a specific time and place to shop, and committing to follow-up medical appointments. Not everyone enrolled has taken advantage of the program, but the majority have–and some quite extensively.

As a metaphor for, or a substitute expression of the universal yearning to return to the land, the capacity to access the bounty of the earth perhaps subconsciously reminds us of the connection to our source and our birthright of health. The mere act of showing up and filling one’s bag with beautiful produce yielded from the soil reflects a powerful commitment to one’s self. Standing witness on that morning shed light on what a new paradigm of healthcare could look like–particularly in response to the problems associated with health disparities–but in the larger context as well. I returned home with a reassurance that my little toddler-aged program was doing well. I can’t wait to see it grow.

Thank you for listening, sharing, following and supporting my writing. Please subscribe in the sidebar to receive notice of new posts. Comments and greetings always welcome.

In health, Elyn

Related Resources: Food Trust/Policy Link:  Access to Healthy Food and Why it Matters;

Double Value Coupon Program–Diet and Shopping Behavior Study

Building Healthy Communities Through Equitable Food Access

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J’s My Plate

 

My Plate Haiku

Food is medicine

Farmers are doctors, Cooks priests

Eat, pray, eat, pray, love.

By Gordon

the new food revolution, food stamp cuts and health disparities

My Dilemma cuddled up next to me in bed and rested its head on my shoulder. “What is coconut palm sugar?”, it asked. I explained tenderly while rubbing its dear little head, that it is a natural product made from the nectar of the coconut palm tree. There are several different varieties of palm, and “coconut palm” specifically refers to the coco nucifera plant. It possesses a low glycemic index making it a healthier choice than sugar refined from sugar cane or beet sugar and is an option for diabetics. My Dilemma looked at me with the pure innocent eyes of a child.

English: Coconut Palm tree on the beach in Nus...

English: Coconut Palm tree on the beach in Nusa Dua Bali Indonesia (Photo credit: Wikipedia)

“And what about goat’s milk kefir?”, it then asked. I answered, “Oh, you know. Kefir is a fermented milk product that originated centuries ago in the Caucasus mountains, made from the milk of any ruminant animal–in this case, goat. The various types of beneficial microbiota contained in kefir make it one of the most potent probiotic foods available.”

I thought it might be drifting off to sleep, but then it muttered, “Can you tell me the story about chia and hemp seeds, lukuma, stevia and mesquite sweeteners, oh and kombucha and cacao nibs?”. Try saying kombucha and cacao nibs five times fast. Wait a minute. Looking its way, I noticed a little smirk on its face.

I realized then it must have been looking through some of my papers that I have lying around among all of my resources. It was getting late and I was not in the mood to be playing games–even the one apparently called, describe the recently sourced foods deemed essential to a really healthy diet and that are alternatives to the substances compromising our health. Really, it is getting hard to keep up with these emerging products. I could have been annoyed but instead just planted a kiss on its little cheek. Besides, my Dilemma is always incredibly patient with me as I stagger about waving my sword attempting to slay the conundrums of our modern world’s feeding debacle. It is essentially the Sancho Panza to my Don Quixote–forever loyal.

I plumped the pillow, pulled up the covers and made sure it was quite comfy. It puffed a little sigh, the kind that signals the final controlled exhale of the day, but then it managed one last exertion. “Do you tell your patients at the Health Center to eat these foods?” I remained still and didn’t say anything. I knew if I ignored it, sleep would blanket its cares and it would choose sweet dreams over reality-drenched answers.

I was glad to lay the matter to rest and tucked myself in for the night. But still, I knew my innocent-seeming Dilemma was playing me. It knows that every day as I walk into my office, I pray that I may not alienate my clients by making totally unrealistic suggestions and that I am grateful as I leave that there is still air in my car’s tires. It is quite aware that I oft apologize when I utter things like extra virgin olive oil, stevia, quinoa, almonds, and organic milk. It knows I choke and can’t say grass-fed, locally raised beef and heirloom tomatoes, and that I break out in hives when considering presenting the advantages of a gluten-free diet for certain individuals.

My economic assessments must be made fast and furiously and I cannot instantaneously calculate what a person’s monthly social security income, low wage earnings and varying food stamp dollar allotment translates into in terms of a daily food budget for themselves and their family. I have no lab values measuring the degree of food insecurity. Many of my clients depend on the graces of food pantries–especially at the end of the month; some live in shelters or at rehabilitation centers with absolutely no control of their food choices.

If quizzed, I would say the majority of my patients know the price, more or less, of white rice, corn or vegetable oil, hamburger meat, chicken and twelve-packs of soda–and messing with their math by offering well-meaning alternatives does not make for good calculus. Though food budgeting education is valuable, most of whom I work with are already experts in that regard. I can’t surmise how much wiggle room someone has in order to make their diet more of a priority, but I must venture in and gather and glean some sense in order to gauge what is possible. At the end of the day, I can only hope that I was close if there is to be any hope of meaningfully promoting diet for health.

A shelf in my office contains food boxes and wrappers, non-perishable examples of “consider this” and “please, whatever you do, try to avoid this” foods. The shelf is not big enough. My patients are kind as they pick up from the floor the items that have fallen as I search for something from my display to show them. For those with grass-fed dreams but ground beef budgets, I have a few things to suggest, though I lament that it is nary enough. These include beans, oats, sardines, milk substitutes, flax seeds, teas, lemon juice, spices, dried apples, low-sodium chicken broth, canned salmon, whole grain pasta, boxed tomato sauce, sunflower seeds, and apple cider vinegar. When I can, I offer little samples. On some days I have coupons for the farmer’s markets, the local food coop, and manufacturer’s products to share-and I do have a small group of patients tucked under my wing participating in Veggie Rx, a Produce Prescription Program that provides free fruits and vegetables on a weekly basis.

Almost everyone is thoughtful, attentive and appreciative and willing to try to do something. Hardly anyone looks at me and yells, “Are you kidding me?” as I proffer a baggie of cinnamon. Still, I need a lot more to ameliorate the consequences of the nutritional junkyard that litters the land and to which those living in poverty are most vulnerable. With sugar at 62 cents a pound and coconut palm sugar going for about $5 for that same amount, what I could really use is a more level playing field if I am going to accomplish my goal of minimizing health disparities.

In the morning, I found my Dilemma curled up on the couch with a cup of coconut palm sugar-sweetened teeccino caffeine-free herbal coffee alternative and the newspaper. “Good morning”, it greeted me. “Just reading about the cuts to the food stamp program.” “Have a good day!”, it shouted after me, as I ran out the door to work.

If you have any suggestions or would like to hear what I think my patients could really benefit from, drop me a line.

Thank you for listening, sharing, following and supporting my writing. Please subscribe in the sidebar to receive notice of new posts. Comments and greetings always welcome.

In health, Elyn

P.S. Please take a moment to watch this beautiful video, Place Matters, by Clint Smith

Related Post: Inventive Incentive

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My Plate Cup

My Plate Haiku

Hunger tiptoes in

From bellies, hearts or minds

Feed me now she calls.

By Eva