About 30 percent of the residents around Temple University Hospital in North Philadelphia live below the federal poverty level.
Many of them do not get enough food, or enough of the right kinds of foods, and their health suffers.
For some, that is about to change. The hospital and Temple's Center for Bioethics, Urban Health and Policy at the Lewis Katz School of Medicine are working with St. Christopher's Foundation for Children to expand the Farm to Families programs already operating in the city to Temple Hospital. Dubbed FreshRx, it will start with physicians writing "prescriptions" for the food - organic fruits, vegetables, and other food provided by the Lancaster Farm Fresh Cooperative.
Nora Jones, an assistant professor of bioethics and associate director of the bioethics center, spoke to us recently about the initiative.
Describe the area you plan to serve. What are the challenges the residents face?
Our primary target area is the neighborhoods around Temple University and the hospital, although there's no requirement that participants live only there.
The latest needs assessment of this area found that 85 percent of adults don't reach the goal of four to five servings of fruits and vegetables a day. And 76 percent of kids don't meet those goals. On average, a little more than 15 percent of residents end up skipping at least one meal a day for financial reasons.
Yet many are obese. Being food insecure and/or experiencing hunger, coupled with a problem with obesity, seems a contradiction. But it makes sense. People have limited resources, and on some level you're just going for caloric intake. It's so much easier and cheaper to get unhealthy food. But it is lower in nutrients, higher in fat, and therefore contributes to obesity and the poorer health that can follow.
North Philadelphia has an access problem; there are not a lot of easily reached locations to buy fresh fruits and vegetables. Also, it's really expensive to try new food, to introduce, say, broccoli into a diet. If you're a mom on a limited budget, trying to put food on the table, why buy something and cook it and serve it if the children won't eat it? One statistic shows that kids take eight times to try something before they like it, before they develop enough of a taste for it that they will eat it. The mom is making a rational choice by not buying broccoli.
What are the health consequences of malnutrition and hunger?
For an infant, being undernourished has an impact on physical and neurological development. They may be more prone to infections because their immune system doesn't have enough oomph. Once they get to pre-school and elementary school age, a lack of nutrition means it's harder to concentrate, it's harder to stay awake. So kids are having more difficulties in school. Sometimes, it's seen as a behavioral problem - not being able to sit still or pay attention - but in many ways it's a nutritional problem. And if they're being hospitalized or taken to the doctor because their immune system is not strong, then they are missing school and not keeping up with their classmates.
We're a little more familiar with the later-in-life problems: diabetes, hypertension, cardiovascular disease. If you're having to do dialysis, it makes it harder to focus at work, harder to maintain a steady presence at work. Being undernourished is very disruptive to your physical body and your social world, as well. Also, the worries of food insecurity can cause stress in the parent, and we know that stress causes physiological damage to the body.
Describe the new program?
Physicians will have FreshRx prescription pads. They will ask patients about food insecurity and, if their patients need help, the physicians can literally prescribe fruits and vegetables.
With the prescription, a family can buy a small box of produce - 12 pounds of fruits and vegetables - for $10, well below what it would cost in a market. A large box, 18 pounds, will cost $14.
Once a week, a Farm to Families coordinator will bring all the pre-packaged boxes to a drop-off point at the hospital. People who have signed up the week before - this is to reduce waste, instead of maybe bringing more food than would be needed - come back the following week and pick up the box.
The program will be year-round. In winter, for instance, the produce would include squash, spinach, and collards, apples, carrots, cabbage, turnips, and sweet potatoes. There also will be recipes, which have been tested and are straightforward. These aren't Julia Child, French cooking recipes. They are designed for a household that doesn't already have 17,000 spices in their cupboard.
So far, the reports from Farm to Families participants have been really good. The low cost enables people to take a chance on different foods. People are finding it affordable, easy, and not cumbersome. And they're enjoying the food.
How is this program different from other programs, such as Philabundance or food stamps?
The difference is the association with the doctor, the low weekly cost, the consistency of delivery and pick-up, and the fact that there's no buy-in cost. You don't have to give any financial information. There are no criteria to enter the program, no qualifications. You just sign up, show the prescription for the discount, and pay. It works on a week-to-week basis. If you have money, you can buy into it for the next week. If you don't, you can skip a week.
Normally, physicians don't have solutions for their patients who don't have enough food. They can make recommendations, but here is a tangible intervention. That will be really empowering for physicians, too. I teach medical students and see their frustration with the negative social determinants of health. Our current system doesn't enable them to do very much about it. This does.
What will you consider success to be?
One measure of success would be if word of mouth spreads among the families, and we get more people using the program. Other measures of success will happen in the patient-doctor conversations. If a doctor is counseling a patient about the good things that would follow if you would be able to eat healthier, then those physicians and those patients are more likely to see those things happen.
We often think of health in terms of what medical procedures you have, what tests you have, what medications you're taking. It is heartening to see so many physicians and local organizations paying attention to food as an important determinant of health.
Temple has created an Owlcrowd fund-raising website for Farm to Families, which will run through Dec. 15. Donations received through that date will be matched up to $25,000. To learn more or make a donation, visit www.giving.temple.edu/farmtofamilies.