A Prescription for Fresh Produce

Every Thursday afternoon from July to September, two vans with trailers depart the Vermont Youth Conservation Corps (VYCC) campus in Richmond, headed to medical centers across the state. In those trailers are what’s known as Health Care Shares, boxes of fresh, local produce recommended by doctors for their patients. The Health Care Share (HCS) program, a collaboration between VYCC, Central Vermont Medical Center, and our Co-op, provides Vermont families experiencing food insecurity, diet-related illness, and other health risks, with the nutritious food they might not otherwise have access to.

We spoke with the program’s coordinator, Claire Londagin, to find out more about how the program works and its potential short and long term impacts across our state. The following are edited excerpts from that conversation.

Claire Londagin, Health Care Share Coordinator AmeriCorps VISTA:

How would you describe the Health Care Share program?

The Health Care Share is a farm to medical center partnership that connects Vermonters in need to fresh fruits and vegetables at their doctor’s office, and ties in youth agriculture education and development. You can think of it as a prescription vegetable program since it is doctor recommended. Many Vermonters, and Americans suffer from “hidden hunger” where they are able to access sufficient calories but lack access to important micronutrients, for a multitude of reasons. The Health Care Share provides them with one avenue to improve their diet and access to those nutrients. We are serving just over 400 member families this year, which comes out to about 1,500 individuals who are impacted just through those family units. We serve Vermonters across five counties, Washington, Chittenden, Orleans, Essex, and Caledonia.

So doctors identify  patientsthey feel could use or need a healthier diet?  

Yes, essentially, the doctor makes that call. We are partners with medical centers, and those medical centers do their own coordination for enrolling members and communicating with primary care providers in their medical center network. We provide some nutrition education components as well as the shares of vegetables throughout the summer and fall, for at least 12 consecutive weeks, longer for some medical centers. For Central Vermont Medical Center (CVMC), which makes up 150 of our members, we have a little more of a hands-on role.

How often and for how long do patients receive a Health Care Share?

The Health Care Share is at least twelve consecutive weeks for all of our medical center partners, from July through September. Some of our medical centers get an additional couple of fall bulk shares, and one of them is getting sixteen consecutive weeks this year. It depends on the individual partnership and the capacity of the farm. Long term, we hope to lengthen the weekly share for more partners and provide fresh produce to our HCS members throughout the late fall.

How many medical centers are there that you work with?

We have five medical center partnerships, but some independent medical centers work together to coordinate their HCS members, so you could look at it as over five partners. We have two up in Orleans County, there’s North Country Health Clinic, and then there’s North County Hospital, they work together to facilitate the Health Care Share for folks in Northern Vermont. We have Richmond Family Health, right here in Richmond, Central Vermont Medical Center, University of Vermont Medical Center, and, new this year, in St. Johnsbury, is Northeastern Vermont Regional Hospital.

Some of the vegetables are harvested Wednesday morning, washed, and packed that afternoon, and delivered on Thursday?

Yes, harvest happens as early as Monday and as late as Wednesday afternoon.

So patients are getting some of this produce literally out of the ground the day before?

Yes, it’s really fresh produce, which is awesome.

Is there anything that always goes in every share? Or are the individual shares different?

We do our best to have them all be the same. Today, kale and onions are going in every single share. Most things go in all 400.

But throughout the season, week to week, things will be different?

Yes, every week the share varies based on what’s ready to be harvested, in our microclimate in the Winooski River Valley. I think every week so far we have had kale in there as well as scallions and fennel, but those are the only things that have been in every single share so far. Even that will change. Share contents will change week to week.

Do you have a sense of the impact over the long term for the members who have been getting the shares?

The most impactful numbers are just how many people are being served, especially how many children and how many seniors over the age of 65. I think that’s always impactful, knowing that kids are getting access to vegetables, and important micronutrients, in their home that they likely would not otherwise. Some of the questions that we ask on our application are pretty intense, and the authenticity you see in those applications has been impactful. In terms of long term health impact, we do ask our member families if they have an overall better sense of well-being after the program ends. We ask them that at week twelve, the last week of consecutive shares for most of our member families. Overall people say, ‘yes, we do feel better, have a better sense of well-being,’ and they do feel more food secure. However, we have not tracked the responses of people who have been in the program for years to see if there is a statistically significant long term impact of the program.

Do you have a sense of how many years the average member is in the program?

Overall in 2018, 32% of member families were returning for a second or more year, but it varies a lot. I have a sense for our 150 CVMC members, as those are the folks we have the opportunity to work with directly. The other medical centers, we don’t have any direct involvement with their members. There are CVMC members who have been in the program for eight seasons! Although I would estimate most returning members are in the 2 to 3-year range.

What is the application process for members?

While there are some standardized questions on the application, the medical centers get to decide who they enroll. Some of them focus more on the diet-related disease, and some focus more on food insecurity. Those things are interconnected, and if you can catch families who suffer from food insecurity who have children and provide them with better access to nutrient-dense and fiber-full foods, those children are less likely to suffer from diet-related disease later in life. Some medical centers focus on one more than the other, some serve both. At CVMC, we serve both of those groups.

Can people apply if they haven’t had a doctor recommend it to them? Or does it have to be prescribed by a doctor?

The way that members are meant to get applications is to go through the doctor’s office. If we get an application from CVMC that does not have a doctor’s signature on it, we connect with the medical center and make sure the applicant is a patient who is getting some kind of primary care there. As long as people are scoring as food insecure and/or have a doctor’s signature on the application, it’s first-come, first-serve, as we receive the applications.

You must have waiting lists?

For the CVMC partnership, we do have a waiting list. There were five members who were un-enrolled last week for various reasons, which meant that five people got in to the program off of the waitlist. The waitlist seems to go pretty quickly. We still encourage people to apply, even at a late point in the season so that they can get on the waitlist.  

What kind of education do you provide to members?

We provide a weekly newsletter that goes in every share, with some information about the farm but mostly information about the food that’s in the share, nutrition education, and recipes. We hope that the person who is using the food in that household gets a hold of it and can use it as a resource. The University of Vermont graciously prints a nutrition and recipe resource notebook each season for every member family. We also encourage our medical center partners to provide some sort of hands-on educational component so that the HCS can be more than a simple food assistance program. We like exposing people to new foods, and a lot of our medical centers do weekly taste tests or demos or coordinate classes. University of Vermont has a weekly demo at each of their sites, and they do weekly taste tests, in order to incorporate other ways of experiencing the vegetable instead of just getting a box of raw vegetables. UVMMC and CVMC both provide hands-on cooking classes through the UVM Extension Expanded Food and Nutrition Education Program to eligible Health Care Share members.

Meet three VYCC youth corps members, Molly, Sean and Zane, and read their stories here.