Produce Rx Programs for Diet-Based Chronic Disease Prevention

Abstract

Background: To explore the ethical and policy implications of produce prescription (Rx) programs, PubMed, Embase, and Scopus databases were searched for peer-reviewed literature on existing Rx programs in February 2018. Methods: A review of the literature identified 19 articles published on produce Rx programs; all were included in the review. Inclusion criteria were interactions between a medical professional and patient in a health care setting where a prescription for the consumption of fruits and vegetables was provided. Programs were further classified by whether patients were recruited based on eligibility criteria such as low socioeconomic status, diet-related condition, and the type of referring physician. An ethical matrix was then used to evaluate well-being, autonomy, and fairness from the perspectives of adult and child patients, patient families, participating local farmers, physicians, and government assistance programs. Results: Patients with low income were subjects of 14 articles; 13 studies identified populations with diet-related health conditions such as diabetes or hypertension. Only 9 studies examined both health conditions and low socioeconomic status. An ethical analysis indicated that despite reducing financial burdens and increasing food choice, Rx programs might have unintended psychosocial consequences on participants with low income. Health care professionals benefit from employing a partnership model of care, building trust, and emotional intelligence. Participating farmers benefit from an enlarged customer base but might experience greater financial burdens. Some produce Rx programs could use existing government assistance programs (ie, Medicaid in medically underserved areas or the Supplemental Nutrition Assistance Program, or SNAP, in food deserts), although disbursement may be cost inefficient and disorganized without policy cohesion at all levels of government.

A pilot randomized controlled trial of a fruit and vegetable prescription program at a federally qualified health center in low income uncontrolled diabetics

“…In more impoverished areas, many have limited ability to purchase fruits and vegetables due to cost or limited availability in stores selling fresh produce in their neighborhoods. These challenges can often lead to a poor diet ( Swartz, 2018 ). When incentivizing people to eat more fruits and vegetables, they may be more likely to eat less junk food and consume healthier food.…”

Home Food Environment Changes and Dietary Intake during an Adolescent Behavioral Weight Loss Intervention Differ by Food Security Status

“…Connecting families to existing community resources capitalizes on sustainable methods for reducing food insecurity; yet efforts will be needed to ensure families overcome prominent barriers to accessing these food resources (e.g., transportation, difficulty with enrollment) and obtain healthful foods that improve diet quality. Another approach could involve fruit and vegetable prescriptions as a component of obesity treatment, similar to recent approaches implemented within routine clinical care [ 40 ]. Fruit and vegetable prescriptions may provide a low-risk opportunity to expose families to nutrient-rich foods that improve diet quality; yet this strategy may not serve as a long-term sustainable solution for improving nutrition security.…”

Adoption and implementation of produce prescription programs for under-resourced populations: clinic staff perspectives

“…The study with hypertensive patients had similar findings ( 11 ). Both that study and ours involved “safety net” clinics, in which physicians face greater time and other resource constraints in working with medically underserved populations ( 22 ). It will be important to continue to conduct implementation research to understand the best role for physicians and other clinic staff in different types of clinics.…”