Doctors prescribing free vegetables; Bristol program aims at overall health

BRISTOL — What if your doctor prescribed you asparagus instead of aspirin?
A few weeks ago, Charlotte Sullivan visited the Mountain Health Center in Bristol for an appointment and walked out with a unique prescription — she had secured free vegetables for the next six weeks.
Sullivan, who lives in Bristol, is a participant in Mountain Health’s new Health Care Share pilot. The program delivers weekly bundles of locally grown veggies to the office on Munsill Road, where 15 qualifying households pick up their share for six weeks during the peak growing season.
Sullivan had typically eaten fresh vegetables at least twice a day, but recent “unexpected developments” changed her income and forced her to adjust her diet toward cheaper, more processed foods. She qualified for the program by taking a short survey asking her if income was a barrier to buying healthy food, if she had a health or lifestyle concern related to her diet, and if she was interested in the program.
Though it may seem small, this six-week pilot in Bristol could have big implications for the future of our healthcare system.
The pilot is funded with a small grant from the local Department of Health Office as part of a statewide “3-4-50” campaign.  The numbers refer to the three behaviors (lack of physical activity, poor diet, and tobacco use) that lead to four chronic diseases (cancer, heart disease, type 2 diabetes and lung disease) that cause over 50 percent of deaths in Vermont.
Funding will only last one short season, but there is plenty of potential for the program to continue and expand in Addison County, as it has in Newport, Brattleboro, Rutland, Central Vermont and Burlington.
As Vermont transitions its health system to focus on preventative solutions, the time is ripe for identifying programs that actually make people healthier. The Health Care Share is one such solution that is breaking open the conversation, according to Moira Cook, District Director for Addison County at the state’s Department of Health.
Health Care Share programs have been popping up across Vermont since 2012. The largest such programs, at Central Vermont Medical Center in Berlin and in Rutland, serve about 150 families each and cover a 12-week season, with monthly pickups when the harvest slows down. This year, over 500 patients will benefit from six programs spread across the state from Bennington to Newport.
Vermont Youth Conservation Corps works at the center of all of them. VYCC employs young people on their seven-acre farm in Richmond who lack access to work opportunities or are considered at-risk. Corps members learn job skills, teamwork, how to grow vegetables, and how to be contributing members of a community. Doctors have started referring not only patients who would benefit from dietary changes, but also youth who could use a job.
Right now, the network has incredible capacity to expand. The Richmond farm has fields ready to be planted, and Program Director Paul Feenan says his mission is to “put as many kids to work as we can.” VYCC plans to grow the program steadily by bringing on one health community every year. After six years and six partnerships, they’ve made steady progress.
But building a Health Care Share program is easier said than done. Paul describes the challenge of uniting a “constellation of revenue sources” in order to sustain a program. He identifies three main ingredients: VYCC, a primary care provider, and a community organization to champion the program.
“It’s that organization that really makes it the community’s own,” he emphasizes, adding that “the degree to which the community is involved is really important for success.”
Communities have shown that these programs matter to them, and they’ve gotten creative to make them happen. In Newport, a group of neighbors concerned about food security and health pulled together Vermont Land Trust and a local landowner to break ground on a new VYCC farm that is ready to double its production next season after starting out with 60 shares. The local co-op is helping out as well.
Other collaborations run their Health Care Shares without any support from VYCC. The Vermont Farmers Food Center, a grassroots nonprofit situated in a refurbished warehouse, is in its third Health Care Share season in partnership with Rutland Regional Medical Center. VFFC purchases its produce from small, new farms that are anxious for reliable sales. Instead of VYCC’s focus on youth development, VFFC furthers its mission to build vibrant local agricultural economy, which includes healthy food access for all.
Heidi Lynch is the person most responsible for the proliferation of Health Care Shares across the state. She started her work at VYCC and has been with Rutland’s program since the beginning. She believes that every community in Vermont has the necessary ingredients for a Health Care Share program.
Farms are ubiquitous, as are local health clinics and hospitals, but Lynch is also proud that Vermont has “amazing nonprofit organizations and faith-based communities are tremendous at generating volunteer activity and community support.” By “aligning with the institutions that are there,” she says, “we can pull the pieces together for the scale needed for that community.”
Lynch emphasizes that the program is accompanied by copious newsletters and education materials to get families acquainted with foods that may be unfamiliar. Ideally, Health Care Shares are a gateway to other nutrition outreach services, such as the “Crop Cash” program that doubles the purchasing power of 3SquaresVT families at farmers markets.
The benefits of a healthy diet are undeniable, but measuring real health outcomes has proven difficult for program administrators. Long-term results like BMI reduction and lower disease incidence take years to unfold. Until the hard numbers can be presented to insurance companies, it’s unlikely the state will see doctors writing real prescriptions for vegetables.
For now, the overall positive impact is obvious to Lynch and others. “We know that [eating more vegetables] is beneficial to health, period,” Lynch explained. “We know that this program is helping to make that happen. It’s clear from the number of people who show up week after week and have been in the program for multiple years.”
Moira Cook, District Director at the Department of Health, set up the Mountain Health Center partnership as “just a way to kick things off” in Addison County.
If the Health Care Share is going to continue in the county, she and others said, a constellation of partners will work to support it. Those organizations have yet to emerge, but that doesn’t surprise anyone with the first round of the pilot still in full swing. In Paul’s words, “it’s a community development effort that takes a lot of investment.”
Moira Cook speculates that Mountain Health Center’s status as a Federally Qualified Health Center could lead to some extra support from Washington. Senator Bernie Sanders is a strong advocate, but that policy has yet to come down the pike.
In Bristol last Thursday afternoon, another participant in the program is a little more skeptical about the direct benefits of the program. But he does admit that his stomach has felt better recently. His heartburn went silent for a few days, so he’d stopped taking Prilosec.
As for Sullivan, the benefits go beyond nutrition. She’s grateful that her healthcare providers share her values. She smiles, clutching her box of spinach, peppers, beets, onions and more. “I feel healed already,” she says.

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