One City is Giving People a ‘Prescription’ to Eat Fruits and Veggies

The farmer's market in Union Square has over 140 local vendors during its peak season.

The farmer's market in Union Square has over 140 local vendors during its peak season. Shutterstock

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New York City is trying to make healthy food more accessible to its residents, including helping low-income people shop at farmers markets.

Obesity is an epidemic in New York City. Over half of the city’s residents are obese or overweight, and the pounds have accumulated disproportionately on low-income people who lack access to healthy eating options and nutrition education. 

Now, the city is making an effort to reach New Yorkers from all five boroughs and encourage them to embrace healthier eating practices—but assistant commissioner of the Bureau of Chronic Disease Prevention, Kim Kessler, says that’s not an easy task in a city known for dollar pizza slices, curbside food carts, and bodegas loaded with junk food. “It’s a tough environment for New Yokers because the city offers a lot of unhealthy choices that are highly available,” she said. “We’re counterbalancing that by focusing on diet.”

The plethora of unhealthy choices are not only highly available—they’re also usually the cheapest food around. One recent report found that over half of Americans feel “forced” to buy unhealthy foods because they can’t afford more expensive options like produce.

One idea the city uses is to try to make it easier for low-income New Yorkers to buy fresh fruits and vegetables. For years now, an initiative called Health Bucks gives people enrolled in SNAP $2 coupons to spend at one of the city’s 139 farmers markets. SNAP, formerly known as food stamps, is a federal nutrition program that helps recipients purchase food at grocery and convenience stores, as well as some participating farmers markets. Though the Health Bucks program, for every $5 spent at a farmers market using SNAP, recipients get one coupon, allowing them to purchase more goods. 

Now the city is looking to expand the concept by enlisting a new authority to encourage people to eat fruits and vegetables: the local pharmacist. The Pharmacy to Farm program provides 1,200 SNAP participants with high blood pressure a “prescription” for produce. 

The program was first launched as a pilot with three pharmacies in 2017, and expanded last summer to 16 pharmacies. Kessler said that the program is effective because it provides health advice from trusted sources. “Pharmacies are an important part of every neighborhood, and in low income neighborhoods, people are used to getting support and advice from pharmacists,” she said. 

The city has worked closely with local independent pharmacists to train them in the program’s administration. When SNAP participants come in to pick up hypertension medication prescriptions, pharmacists can write them an additional “prescription” for Health Bucks, which they can pick up from a stall at their local farmers market. 

A CDC-funded evaluation of the original Health Bucks program found that three-quarters of users said that they bought more at farmers market and ate more fruits and vegetables because of the program.

Kessler said the city has focused on diet—which has included a host of initiatives, such as requirements for chain restaurants to list calories on menus—because the leading cause of premature mortality in the city is heart disease, often a complication of weight. Other prominent health issues in the city, like strokes and diabetes, are also tied to diet. 

New York isn’t the only local government to use farmers markets as a gathering space to encourage better diets. Farmers market incentive programs have spread to many major cities across the U.S., including Austin, Boston, Chicago, Los Angeles, Seattle, and Washington, D.C. But some recent studies, including one published in the Graduate Association for Food Studies, have found that “SNAP recipients are often unaware of opportunities to use their benefits at markets, and may perceive markets to be culturally inaccessible, inconvenient to access, or more expensive than conventional retailers.”

To spread the word about diet initiatives in New York, the city relies on community organizations. Nonprofits and neighborhood groups organize farmers market walks to help new users feel comfortable spending SNAP at the stalls, and help with nutritional programming at the markets. That programming includes elements like planning a balanced diet and culinary demonstrations in English, Spanish, Bengali, Cantonese, and Mandarin, depending on neighborhood demographics. 

Kessler said that SNAP customers have spent millions in benefits at farmer’s markets since the inception of the Health Bucks program, and that number is expected to rise as initiatives like Pharmacy to Farm help spread awareness. “Farmers markets are a wonderful asset to get produce that’s seasonal and lasts a long time,” Kessler said. “Our programs are designed with the knowledge that access to healthy food is the first step to a healthier life.” 

Emma Coleman is the assistant editor for Route Fifty.

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