Pharmacist Adaoma Chinweuba recalls a patient in Ward 8 whose thirst led to drinking a large amount of soda — and then a trip to the ER.
She asked the patient: “Did you know that, as a borderline diabetic, what you eat and drink can impact your condition?”
“No!” was the shocked response.
Similar incidents, according to Chinweuba, occur all too frequently in Ward 8, an area with high incidences of diabetes, infant mortality, and obesity. But a new pilot program stands to help residents struggling with chronic conditions to plan and eat healthier meals.
Through Produce Rx, AmeriHealth Caritas works with participating clinics managed by Unity Health Care and Community of Hope to provide patients with chronic conditions such as diabetes, prediabetes and hypertension with a “prescription” for vouchers worth $20 per week to purchase fresh produce at Ward 8’s Giant Food Store at 1535 Alabama Ave. SE. It’s the latest front in the push by local nonprofit D.C. Greens to improve food justice and health equity.
Despite efforts to entice other grocers, the Giant is Ward 8’s only full-service grocery store — a marked contrast to neighboring Ward 6, where a Street Sense Media analysis identified 11 grocery store locations in 2017. A protest over this inequity drew more than 200 participants that October. Good Foods Markets has since broken ground on a Ward 8 location expected to open later this year, but concerns remain about access to fresh, nutritious food.
D.C. Greens Executive Director Lauren Shweder Biel notes that the group also runs a D.C. Department of Health-funded program called Produce Plus, which provides a $10 weekly check to D.C. participants in the food stamp, Medicaid, Temporary Assistance for Needy Families, SSI Disability and Qualified Medicare Beneficiary programs for use at participating farmers markets throughout the city.
Last year, over 9,000 people took part in Produce Plus. Benefits extend beyond good food alone. Many Produce Plus participants help build awareness by acquainting their neighbors and friends with the markets and healthy food options. Participation in Produce Plus is highest in wards 7 and 8, with approximately 45 percent of customers residing in those wards.
It’s needed, proponents say. Supermarkets are scarce east of the Anacostia River and produce is more expensive than many other food items, putting a strain on the budgets of people with limited means. Additionally, median household incomes in Ward 8 ($30,910) and neighboring Ward 7 ($39,165) pale when compared to Northwest D.C.’s Ward 2 ($100,388) and Ward 3 ($112,873), whose more affluent residents can afford to select health-oriented fare even if it costs more than other options.
That lack of affluence in Ward 8 takes its toll. “Look at the health statistics in the city,” urges Jillian Griffith, the Ward 8 Giant’s licensed dietitian nutritionist. The ward has the lowest life expectancy rate in D.C. at 69 years, and Ward 7 is little better at 71.7 years. In contrast, the 2018 D.C. Health Equity Report puts life expectancy in Ward 3 at 86.1 years and Ward 2’s at 85.2 years.
Griffith details the difficulties many people in Ward 8 face. Combine the cost of produce with high rents and a lack of good transportation options to reach Ward 8’s sole full-service grocery store and it is no wonder many residents experience “food insecurity” even with the help of Produce Plus.
“It’s a myth that people do not want fruits and vegetables,” explains Griffith. “People love fruits and vegetables.” But people with limited incomes are confronted with “difficult choices.”
Even the bulk of produce items can become a stumbling block. “If you take the bus,” Griffith says, “how much food can you transport back in one trip?”
Awareness of these obstacles led D.C. Greens to start advocating a few years ago to expand a more limited version of the “prescription” program so that it would cover full-service grocery stores. A smaller, citywide program already provided a limited number of AmeriHealth patients with prescriptions for use at farmers markets. But D.C. Greens worked with Ward 3 Councilmember Mary Cheh, D.C. Health, and AmeriHealth Caritas to launch the current, more ambitious version of Produce Rx, allowing redemption of the vouchers at grocery stores. Last spring, Cheh, chair of the council’s Committee on Transportation and the Environment, collaborated with Ward 7 Councilmember Vincent Gray, chair of the Health Committee, to fund the expanded Produce Rx program for one year. With this week’s budget vote, the funding was tentatively extended through 2020.
Under the program, patients of AmeriHealth 18 years or older on Medicaid and diagnosed with prediabetes, Type 2 diabetes or hypertension are eligible. Patients do not need to be Ward 8 residents, but most of the referring community clinics are located in Ward 8, as is the only currently participating supermarket.
Participants can redeem their “prescription” at Giant for either a weekly or biweekly produce voucher but are required to meet regularly with their health care providers to monitor their vital health signs and obtain renewals. Participants are urged to attend nutrition classes to learn about the benefits of increasing their consumption of fresh fruits, vegetables, and whole grains.
Griffith and Chinweuba say that better food options can help people who have prediabetes or are susceptible to high blood pressure or diabetes to better manage their conditions — potentially with less medication. “What people eat has a lot to do with how their body responds,” says Chinweuba. Avoiding food high in processed sugars, sodium, and saturated fats can help people better manage their blood sugar and blood pressure. But making healthier choices can involve not just being able to pay but also breaking old thinking.
“It takes a little planning,” admits Griffith. “Many people like relatively cheap potato chips as snacks even though they contain noticeably higher levels of sodium and fat when compared to carrot sticks with hummus or celery with peanut butter and raisins.”
Although Griffith says Produce Rx provides participants with “more flexibility” in their budgeting and food choices, that’s not the only benefit. Getting more people to eat diets heavy in fruits and vegetables could help save D.C. and federal health agencies money given the high cost of ambulance trips, ER visits, prescription medicine and treatments associated with poorly controlled chronic conditions, proponents say
The pilot program has funding through December 2019, according to a press release from Giant Food. Its future now looks more secure as well, with the D.C. Council reversing the mayor’s cut to Produce Rx. The 2020 budget that won initial approval Tuesday includes $330,000 for the program. In early May, Cheh’s Transportation and Environment Committee approved funding for Produce Rx and several other nutrition-related programs through a 1 percent increase in the soda tax. The funding source initially drew objections on procedural grounds, though Cheh attributed the dissension to efforts by “big soda” to derail the tax hike.
“With these funds, doctors at partner clinics will be able to continue writing prescriptions to approximately 500 patients in Ward 8,” according to the council’s draft committee report. “Further, this enhancement will position the District to build new partnerships with clinical providers and receive new federal dollars via a produce prescription title in the Farm Bill.”
Ideally, D.C. Greens hopes that analyses of the Produce Rx program prove its cost-effectiveness, and Shweder Biel speaks optimistically about Produce Rx eventually covering the entire city. “It’s wonderful to serve 500 patients,” she said before adding that helping more D.C. residents migrate to healthier diets would be even more wonderful.
This article was co-published with TheDCLine.org