While the majority of U.S. households are food secure, food insecurity continues to be an issue for many Americans. According to the U.S. Department of Agriculture (USDA), 10.2% of households were food insecure during at least part of 2021.
Among those affected are veterans, who are 7.4% more likely to live in food-insecure households than non-veterans. Between 2015 and 2019, 11.1% of veterans between the ages of 18 and 64 lived in food-insecure households, with 5.3% living in households with very low food security, described by the USDA as “the most severe range of food insecurity where households report reductions in food intake.”
The U.S. Department of Veterans Affairs (VA) Veterans Health Administration appears to recognize the problem. “Last year, [the] VA decided that addressing food security was important enough that we dedicated and built an office just focused on veteran food security,” said Dr. Christine Going, acting senior advisor at the new VHA National Food Security Office. “It was deliberately put within healthcare because we do feel strongly about the connection between food security and healthcare.”
Not only is the VA aiming to increase access to food in general; it’s also looking to improve health outcomes for veterans by preventing and managing diet-related illnesses. Diabetes, for example, is more prevalent among veterans than in the general U.S. population.
The VA’s also working hand-in-hand with philanthropy to step up its response. It recently partnered with the Rockefeller Foundation to increase access to healthy foods and improve health outcomes for veterans by supporting two “produce prescription” pilots — one in Salt Lake City, Utah, and the other in Houston, Texas. Eligible veterans will get $100 a month for 12 months to purchase fresh produce, along with nutrition education from VA-registered dietitian nutritionists.
“Our mission is to ensure that all veterans have equitable access to nutritious, affordable and culturally appropriate food to support veterans’ health through data management, partnerships and using evidence-based strategies to inform healthcare delivery to create an environment where all veterans are food and nutrition secure,” Going said. “That’s kind of our bottom line: One hungry veteran is one too many.”
The Rockefeller Foundation is providing a $1.4 million grant to Fresh Connect — which will operate the program — and to the University of Utah, where researchers will evaluate the pilots’ impacts and outcomes. The grant builds on Rockefeller’s Food is Medicine program, which aims to integrate food and nutrition into healthcare to fight diet-related diseases.
“For us, this is an incredible opportunity to expand Food as Medicine for a group of Americans that has high food insecurity and higher diet-related diseases,” said Diana Johnson, manager of the Food Initiative at the Rockefeller Foundation. “And so success for us looks like seeing high uptake of the program, seeing veterans engaging in this particular service and ensuring that the programs will meet the needs of the veterans that are enrolled.”
Food is medicine
The Rockefeller Foundation has a long record as a food and agriculture funder, reaching all the way back through its 100-year-plus history. Priorities have shifted during that time, with food productivity rising high on the agenda during the mid-20th century as Rockefeller played a central part in philanthropic backing for the controversial Green Revolution. Nowadays, though, Rockefeller’s food funding is much in line with contemporary progressive prerogatives — its current goal is to improve global food access and build “a more regenerative, nourishing and just food future.” To that end, Rockefeller launched its new Good Food Strategy last year, which will invest $105 million over three years to increase access to healthy and sustainable foods around the globe.
One of Rockefeller’s major focal points in its Good Food Strategy is its Food is Medicine programs, which include things like medically tailored meals and the produce prescription programs it’s piloting alongside the VA. By better integrating food and nutrition into general healthcare work, Rockefeller hopes to address the ever-increasing prevalence of diet-related chronic diseases, which reached historic levels in both children and adults during the pandemic.
“Food is Medicine programs can lead to better health outcomes for people and save millions of dollars in healthcare costs,” Johnson said. According to Rockefeller, the U.S. spends a whopping $1.1. trillion a year treating chronic diet-related diseases, including heart disease, stroke and diabetes. “Integrating nutrition into our healthcare system means doctors can prescribe produce or healthy meals as easily as pharmaceuticals and reduce the need for expensive and invasive health services,” Johnson said.
The partnership between the VA and Rockefeller was “a natural fit,” according to Going at the VA. As the largest integrated healthcare system in the U.S., the VA provides care for more than 9 million veterans at over 1,200 healthcare facilities across the nation. Philanthropic partnerships with such an expansive system could mean ample scope for wide-ranging impact.
“We are working with the VA because there’s a huge opportunity to support veterans’ food needs and diet-related conditions through Food is Medicine programs,” Johnson said. “Expanding Food is Medicine programs through the veteran health system will help to address the impact of diet-related diseases and food insecurity among veterans, and will also help us evaluate the impact of these programs to help us build a better case that these programs should be embedded in healthcare delivery as a benefit for millions of Americans.”
Increasing access to produce
How, exactly, will the produce prescription pilots work? It’s pretty straightforward. As part of their primary care, veterans are screened for food insecurity. When a veteran screens positive for food insecurity, they will be referred to see if they meet other criteria needed to qualify for the program. If they do, they’ll be given the opportunity to sign up.
From there, Johnson said, they’ll receive a Visa debit card that can be used at participating food retailers in Salt Lake City and Houston to purchase fruits and vegetables, up to $100 a month. There will be a 12-month enrollment window, and within the program, there will be 250 participants per site for a total of 500 participants across both cities.
“What we’re looking for, first of all, is exposing veterans who are food insecure to produce. We know produce can be expensive, and if you’re shopping on a budget and you don’t have a lot of money to spend on food, produce is one of the things that you would normally eliminate. But we also have to understand the value of fresh fruits and vegetables in your diet to be healthy,” Going said. “So we see this as a great opportunity to facilitate… getting fresh fruits and vegetables to this underserved population.”
In addition to the financial incentive, veterans will also be enrolled in a robust nutrition education program. “We feel really strongly that just giving healthy food to veterans, though nice, isn’t going to break the cycle and isn’t going to move them toward thriving. What we’re saying is you can’t just throw food at hunger to solve it,” Going said.
Participating veterans will be enrolled in Healthy Teaching Kitchen programs, which will offer cooking skills and nutrition knowledge so they can cook healthy meals at home. Classes also include discussions about different nutrients, how to balance meals, grocery shopping and meal planning.
“Not only are we giving veterans access to healthy produce, we’re also teaching them what to do with it,” Going said. “We feel really strongly that nutrition education is a key component to this program.”
Learning from the pilots
In addition to providing healthy food and skills to veterans themselves, part of Rockefeller’s $1.4 million grant will go to researchers at the University of Utah, who will evaluate program impact, healthcare costs related to the work, and participant satisfaction.
According to Johnson, the researchers have several specific aims, including looking at the effect produce prescriptions have on measurable health outcomes like BMI, blood pressure and AC-1 levels, as well as looking at the program’s cost effectiveness. Researchers will also look into how the prescription programs can be implemented and scaled beyond the two initial sites.
“Success for us looks like seeing high uptake of the program, seeing veterans engaging in this particular service and ensuring that the programs will meet the needs of veterans that are enrolled,” Johnson said. But beyond this, Rockefeller is interested in building evidence that Food is Medicine programs are something that can work for all Americans, not just veterans.
“We’d love to see this build the evidence that this works,” Johnson said. “It’s really important for us that we have a robust evaluation attached to this program that will really help us build the business case that these programs belong as a part of normal healthcare delivery across the U.S., not just for the VA, but for other healthcare systems, as well.”
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