December 14, 2021

A new project will be exploring the benefits of food prescription programs, which provide a monthly electronic benefit for participants to buy fresh fruits and vegetables. In early studies, this type of intervention has been shown to improve health outcomes. With a $765,000 grant from The Duke Endowment, this project will investigate a new facet of these programs: return on investment in the form of improved health outcomes and lower health care costs for communities. Although produce prescriptions have shown positive results, previous studies have not commonly examined implications for cost. These findings will be valuable for decision making about creating or expanding programs.

Dr. Shu Wen Ng

“A lack of access to healthy food is associated with a host of diseases including Type 2 diabetes, hypertension, heart disease, stroke and diet-related cancers. As a result of systemic racism, low-income, black, indigenous and other people of color are more likely to experience food insecurity and are at higher risk for related health impacts,” said Shu Wen Ng, PhD, Distinguished Scholar in Public Health Nutrition at the UNC Gillings School of Global Public Health and the principal investigator of this new project.

The COVID-19 pandemic only worsened these issues. Addressing gaps in the availability of healthy food stands to improve health outcomes, reduce disparities, and save money for overburdened health care systems.

Dr. Thomas Keyserling

Dr. Thomas Keyserling

“We think this project has the potential to help identify and find evidence towards a financially sustainable, innovative and scalable model in support of providing additional financial resources for low-income individuals with diet-sensitive chronic health conditions to access healthier foods,” said UNC Gillings alum Tom Keyserling, MD, MPH ‘90 (nutrition), professor of general medicine and clinical epidemiology at the UNC School of Medicine, who is a co-investigator on the project.

Produce prescription programs increase access to healthy food by offering money for patients to buy fruits and vegetables. Durham-based nonprofit Reinvestment Partners (RP) manages food-prescription programs for communities across North Carolina, providing $40 per month for participants through its RPRx program, in partnership with federally qualified health centers, local health departments, the Durham Veterans Affairs Health Care System and Food Lion. Funds are distributed electronically through Food Lion’s customer loyalty program for ease of use and tracking of purchase data.

The RPRx program has already proven effective at increasing the purchase of fruits and vegetables, and higher use of the program was associated with fewer hospitalizations. The study team aims to discover specific health outcomes related to these changes and longer-term effects on health care utilization and costs. These findings will contribute to the evidence base for efforts within the health sector to expand produce prescription programs and inform decisions about incorporating this approach into standard health care delivery and reimbursement.

“The early findings are already powerful: people are buying healthier food because of this program,” said Ng. “We aim to determine the return on investments from a produce prescription program, with the goal of catalyzing the food-as-medicine movement among health care payers.”

This evaluation will consist of two phases. The pilot phase will explore the types of electronic health record data available and a process for extracting and analyzing data. The next phase will involve scaling the approach to data collection and analysis to more clinics with RPRx programs and assessing patient and provider satisfaction.

Non-participants will be matched to participants based on a host of health-related metrics, including weight, height, cholesterol levels, current medication and dietary intake. They will be compared with participants based on health metrics, consumption of fruits and vegetables, and potential health care costs.

Dr. Ashley Price

Dr. Ashley Price

The researchers, including Ashley Price, PhD, MPH, senior researcher at Duke University’s Department of Family Medicine and Community Health, will work closely with participating health clinics and analyze electronic health records to determine changes in health outcomes and utilization and compare them with patients with similar characteristics but not receiving the produce prescriptions. These effects will then be quantified in terms of cost, based on results of a literature review, to determine return on investment for the program, not just in terms of health improvements for participants but also based on dollars saved by the health system. It will provide critical evidence that program designers, evaluators, funders and, critically, policy makers can use to inform decisions about future nutrition prescription programs.

Prior to the pandemic, food insecurity increased health care costs in North Carolina by an average of $1,400 per person. By providing comprehensive evidence of the cost savings associated with these programs, this project is important for future efforts to scale-up food-prescription programs in N.C. and beyond.  The study team is hopeful that it will position N.C to lead the way by incorporating produce prescriptions into Medicaid Transformation initiatives – which could make N.C. a national model for addressing food and nutritional insecurities.

Trained as a health economist, Ng is interested in studying dietary changes and chronic diseases among those experiencing rapid economic and social change. As well as being an associate professor in the Department of Nutrition at the Gillings School, she is also an alum who received a Doctor of Philosophy degree in 2009 from the School’s Department of Health Policy and Management.

Ng is careful to point out that, though this study points to future progress addressing food insecurity, it is just one element of addressing health equity.

“The challenge we are facing is actually one about poverty, mal-distribution of resources and the lack of equitable opportunities,” said Ng. “To more permanently address food insecurity and improve overall wellbeing, there is a need to create and support better paying jobs and vocations, invest in people’s skills training for work and life, and design built environments and zoning laws that encourage the presence of, and allow people to physically access, healthier food options.”

 Based in Charlotte and established in 1924 by industrialist and philanthropist James B. Duke, The Duke Endowment is a private foundation that strengthens communities in North Carolina and South Carolina by nurturing children, promoting health, educating minds and enriching spirits. Since its founding, it has distributed more than $4 billion in grants. The Endowment shares a name with Duke University and Duke Energy, but all are separate organizations.

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