A NEON (Northeast Ohio Neighborhood Health Services Inc) clinic in the Hough neighborhood (Cleveland, Ohio) piloted an innovative way to get fruits and vegetables into the hands of people living with hypertension. One challenge has been encouraging people living with hypertension to establish the daily practices that can keep them healthy, including what they eat. This program offers ongoing education for patients to self-manage their condition, as well as vouchers that can be redeemed at local farmers markets for produce. The NEON clinic went a step further by establishing a farmers’ market at the clinic itself so that all patients can reap the benefits of locally grown food. This means the benefits will extend beyond those with hypertension to their families and everyone who visits the clinic.The Challenge
Heart disease is the number-one leading cause of death in Cuyahoga County, the state of Ohio and in the nation (Cuyahoga County Community Health Improvement Plan, p 44
). One seemingly simple remedy is a diet rich in fresh fruits and vegetables, but there are large sections of Cuyahoga County without grocery stores. Residents have no easy access to fruits and vegetables, and as a result, only one in four consume the daily recommended amount. This is especially important for those dealing with hypertension, as access to fresh produce was identified as a primary barrier to healthy eating. The question is, how can fruits and vegetables be made more accessible to people with hypertension?
Eating more fresh fruits and vegetables can improve everyone’s health, whether or not they have hypertension. Local communities around the country are finding creative ways to bring farmers’ wares directly to schools and neighborhoods or to help residents grow their own. Look for groups in your community working to bring fresh produce to the neighborhoods that need it most and help them explain to business leaders, policy makers and your neighbors how this simple transformation will create a healthier environment for everyone.The Solution
The NEON clinic’s answer is to bring the vegetables to the people, in addition to providing information on healthy eating and setting nutritional goals with patients. NEON is doing this by, piloting a program where patients receive 40 dollar vouchers each month for the farmers’ market after they have their blood pressure checked and receive additional health education. The PRCHN's Kakul Joshi
is the REACH Strategy Coordinator and coordinated the Produce Prescription Program.
She explains that “Even moving patients from no fruit and vegetable intake to one a day makes a difference.” Patients not only learn about what to eat, but also which farmers markets to go to, how to make shopping for fresh produce part of their routine and how it will improve their—and their families’—health. This pilot targets patients who have high blood pressure and are food insecure.
This program has been particularly successful because Mike Sreshta the director of pharmacy at the clinic, reached out to farmer’s market managers to arrange to have a market at the clinic once a week. Kakul Joshi notes, “It is a beautiful integration of clinical treatment and prevention. Prevention is now a stronger pillar of what we do and everyone at the clinic benefits.” Mike Sreshta adds, “It is fulfilling to go beyond my typical role. I like being able to change someone’s outlook. I’ve never had this opportunity before. I feel even more connected to the health of my patients. This isn’t just about taking a pill, it is a lot more.”
This intervention pairs health education with improving access to healthy foods. The program targets patients diagnosed with hypertension who are food insecure. Along with receiving $40 vouchers every month for the farmers’ market, participants also learn about the locations, hours of the markets, as well as which markets accept the vouchers and other subsidies for low-income residents. Participants gain familiarity with the market overall and this supports incorporating the farmers market into their routine. As Mike Sreshta, director of pharmacy says, “most patients are impressed when they learn that healthy eating can be as beneficial as taking medicine when it comes to lowering high blood pressure.”The Results
The best result from this small pilot is that more people with hypertension are eating fresh produce and adopting healthy behaviors that can protect them over a lifetime. As the program almost completes its 2nd month, 77% of the participants have returned for their scheduled PRx visits and have redeemed their vouchers for fresh fruits and vegetables across the network of farmers’ markets in Cuyahoga County. And that benefit extends to everyone they live with and cook for: their husbands, wives, children, and everyone who might be invited to share a meal. Providers can now do more than just talk about healthy options—they’re acting on that advice by ensuring fruits and vegetables are within reach and affordable. Interviews with pharmacists and clinicians show that providers also feel empowered by this program. The whole clinic benefits from having access to the farmers market, even the staff and those who haven’t been diagnosed with hypertension but might be at risk. Patients who participate also learn about other farmers’ market food assistance programs that might be available to them, which will increase their produce consumption even after this pilot ends because they can continue to use those benefits at the markets. Local businesses and farmers also benefit from the increase in their business—and learn about the health benefits of their products to boot. This program has truly supported prevention by effectively strengthening connections between clinics and farmers markets to tear down one of the barriers to good health. Sustainable Success
The model developed by members of the Health Improvement Partnership-Cuyahoga (HIP-Cuyahoga) Consortium and the Ohio State University Extension in Cuyahoga County has paved the way to expand the reach of farmers’ markets into more clinics. The relationships forged through this pilot program will make it easier for the Consortium to instruct other groups so the adoption of the program can spread throughout the region. As its benefits become more widely known, other groups and farmers’ markets are inquiring about how to institutionalize the produce prescription program throughout Cuyahoga County.