Produce Rx: Can Produce Prescriptions Tackle Food Inequality in the United States?

A clear benefit of Produce Prescription programs is fostering healthy behaviors early in life for children of low income families. Studies have shown that participation in Produce Prescription programs can lead to an increase in daily fruit and vegetable intake by more than 30% [10]. Others have observed significant reductions in food insecurity when measured according to the USDA Household Food Security Surveys and the Hunger Vital Sign (HVS) screener. Although the rates of improvement have varied across studies, with as much as a 94% reduction in food insecurity in one study and as little as a 12.5% increase in food security in another, the overall trend suggests positive outcomes [10]. Inconsistent metrics make it challenging to compare programs across states and regions, but programs have generally promoted beneficial behavioral change. For families with children, the impact is twofold: children not only adopt healthier diets early on, but also gain nutritional knowledge and develop lifelong healthy eating habits.

Proponents of Produce Prescription programs also emphasize their role in strengthening local communities. Since Produce Prescription programs consist of local networks between physicians, farmers, grocers, and the government, they foster collaboration and mutual support between community partners. These partnerships increase customers for local businesses, supporting local economies and promoting community engagement. Furthermore, low income individuals who are supported by their community in this way feel a greater sense of belonging and garner psychosocial benefits by participating in Produce Prescription programs.

Additionally, Produce Prescription programs enhance provider-patient relationships. Improved trust between patients and providers can lead to increased adherence to treatments and participation in preventive care [6]. Realistically, Produce Prescription programs alone are unlikely to slow the progression of illness in low-income patients, as they do not address significant financial barriers to affording specialized care (a major factor that contributes to socioeconomic health disparities) [9]. Nonetheless, by cultivating trust in healthcare providers and promoting positive attitudes towards healthy behaviors, these programs may reduce the risk of serious illnesses and minimize the need for costly specialized care.

While Produce Prescription programs have been successful at disseminating nutritional knowledge and encouraging healthier habits among low-income families, many barriers still prevent long-term participation. For example, a 2022 study of a produce prescription program in Washington, DC found that around 80% of respondents were “very or completely satisfied” with the produce variety and educational components [5]. Despite this high satisfaction rate, the 12-month attrition rate for the program was 40% (10 out of 25 families), with families citing “time and responsibility constraints” as the primary reasons preventing their continued participation in the program. So why do families, even when motivated to stay, struggle to remain in Produce Prescription programs?

Having little room for error or wastefulness may be one reason families struggle to maintain their participation in Produce Prescription programs. In spite of having access to fresh produce, some parents worry about wasting food and money by buying fruits and vegetables that their children will not eat [4] . In turn, even parents who understand the importance of proper nutrition choose not to purchase or prepare the recommended portions of fruits and vegetables in order to preserve limited resources. Along similar lines, the time invested in preparing fresh produce, particularly vegetables which often need to be cooked before consuming, can feel impractical for working parents [4]. In the Washington study, participants watched only 66.8% of recipe videos on average, and attendance at monthly educational classes dropped to less than 25% over the program's 12-month duration [5]. When both time and money are strained, families may simply not have the energy and capacity to also sustain a healthy diet.

Competing financial priorities present another challenge. Storing and preparing fresh produce requires additional resources like refrigerators, kitchen utensils, and cooking appliances. Without providing these necessities to families, Produce Prescription programs may unintentionally create additional expenses and burdens for low-income families. Although food is a basic necessity, it can be difficult to prioritize a well-balanced meal over shelter and electricity and heat, particularly in colder months. In areas with suburban sprawl or low population density, where transportation often requires a personal vehicle, the limitations on where program participants can purchase their produce poses additional challenges. Most programs offer vouchers to be used at local farmers markets or select supermarkets. Individuals who borrow cars or take taxis to grocery stores may only make trips once a month, often buying their groceries in bulk. This restricts their ability to consistently access fresh produce, as it is less suitable for long-term storage [3].

From a psychosocial perspective, the stigma around using Produce Prescription vouchers can also deter engagement in the program. With the increased utilization of credit/debit cards and electronic payment methods, vouchers are easily identifiable and can invoke feelings of shame or embarrassment [1]. In some cases, supermarket employees not trained to use Produce Prescription vouchers have unintentionally exposed the socioeconomic status of customers, further contributing to discomfort for participants [13]. Notably, when one California pilot program used gift cards instead of vouchers as a financial incentive, participants cited it as a major positive, as they felt that they experienced less stigma than when using TANF or SNAP EBT cards while also having greater autonomy in their product selections [11]. Designing Produce Prescription programs in a way that minimizes the user’s emotional distress is important to retaining program participation over time.

Produce Prescription programs have been able to promote modest improvements in fruit and vegetable intake among low-income families. Positive feedback from participants and recent political support highlight the potential of these programs to reduce serious health issues among low income families and address socioeconomic health disparities in the United States. However, limited program retention rates reflect the unmet needs of low-income families that cannot be fully addressed by Produce Prescription programs alone. While Produce Prescription programs are valuable in their ability to foster behavioral change in vulnerable populations, expanding the number of participating grocery locations and improving the design of financial incentives could increase program retention. Moreover, food equality advocates must push for broader structural changes including stable, affordable housing and higher minimum wage alongside Produce Prescription programs in order to actualize lasting, meaningful change.