Objective: To evaluate a Produce Prescription Programme’s utilisation, and its effects on healthy food purchasing and diabetes control among participants with type 2 diabetes. Design: Prospective cohort study using participants’ electronic health records (EHR) and food transaction data. Participants were categorized as “Frequent Spenders” and “Sometimes Spenders” based on utilisation frequency. Multivariate regressions assessed utilisation predictors; and programme effects on fruit/vegetable purchasing (spending, expenditure share, variety) and on diabetes-related outcomes (HbA1c, BMI, blood pressure). Setting: Patients enrolled by clinics in Durham, North Carolina, USA. Participants received $40 monthly for fruits and vegetables at a grocery store chain. Subjects: 699 food-insecure participants (353 with diabetes). Results: Being female and older was associated with higher programme utilisation; hospitalisations were negatively associated with programme utilisation. Frequent Spender status was associated with $8.77 more in fruit/vegetable spending (p < 0.001), 3.3% increase in expenditure share (p = 0.007), and variety increase of 2.52 fruits and vegetables (p < 0.001). For $10 of Produce Prescription Dollars spent, there was an $8.00 increase in fruit/vegetable spending (p < 0.001), 4.1% increase in expenditure share, and variety increase of 2.3 fruits/vegetables (p < 0.001). For the 353 participants with diabetes, there were no statistically significant relationships between programme utilisation and diabetes control. Conclusions: Programme utilisation was associated with healthier food purchasing, but the relatively short study period and modest intervention prevent making conclusions about health outcomes. Produce Prescription Programmes can increase healthy food purchasing among food-insecure people, which may improve chronic disease care.
Urban public food procurement can address malnutrition and improve the beneficiary experience at public institutions whilst reshaping food systems to be healthier and more sustainable. We reviewed grey and peer-reviewed literature on urban public food procurement in Kiambu and Machakos counties in Kenya. From the literature, we selected programmes for case study research through stakeholder interviews and targeted literature searching. We searched 11 databases and reviewed 23 relevant articles. The case studies involved early childhood education centre and primary school feeding, hospital food provision, and COVID-19 responses. We found that actionable data and public–private partnerships are enabling factors. Similarly, multistakeholder involvement and governance increase coordination. However, budget constraints threaten programme stability. Procurement criteria focused on nutrition, food quality, and community development, but did not explicitly include environmental sustainability. We linked case studies to the United Nations Sustainable Development Goals 2, 3, 4, 5, 8, and 12. By developing, improving, and scaling public food procurement, urban governments in low- and middle-income countries (LMICs) can reach the most vulnerable whilst improving farmer livelihoods, creating business opportunities, and addressing environmental concerns. This paper contributes implementational insights in Kenyan urban contexts by highlighting opportunities for local and regional policymakers in LMICs and their partners to strengthen public food procurement.
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