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Food Insecurity: Tools and Resources to Bring Food as Medicine to Agricultural Communities

Farmworkers with watermelons.

Yolo County, California sits just northeast of the San Francisco Bay Area, with rolling coastal foothills sloping down into the fertile Sacramento Valley. The output of this agricultural region is diverse, from tomatoes and seed crops, to rice, wheat, and other grains, to fruit and nut orchards. With a poverty rate of 19.5%, Yolo County is the most impoverished county in the state. Consequently, food insecurity is a concern.1 

To better understand the food needs of the county, Yolo Food Bank and partners launched its first Yolo County Food Access Survey. The results, released in April 2024, found that 29.2% of Yolo County households are food insecure. Of those working in Yolo County’s agricultural industry, however, the number rises sharply: 52.9% of agricultural worker households are food insecure. Of households that were food insecure, 27% did not know they qualified for food assistance, and 17% said the food provided by food banks rarely or never meet their traditional, cultural, religious, or nationality needs. Almost 21% did not know where to access food assistance. 

Yolo Food Bank’s newest project in partnership with Sutter Health seeks to address these concerns specifically for agricultural worker families. Its new Cultivo program features pop-up food distributions that mirror the popular and effective mobile health clinics that have become a mainstay in meeting the health needs of migrant agricultural worker communities across the country. The pop-ups will bring fresh, culturally appropriate foods to the fields, farms, packing plants, canneries, and residences to reduce access barriers. 

The new initiative builds on clinicians’ longstanding history of using food as medicine. Jack Geiger, MD, the founder of the modern community health center movement, saw children dying in the Mississippi Delta region of malnutrition and diarrhea, so his team began writing prescriptions for food, paying for the food out of the pharmacy budget. When those payments were questioned by the state government as inappropriate, Dr. Geiger responded, “The last time I looked at my textbooks, the most specific therapy for malnutrition was food.” Since the formation of the health center system, such efforts like produce prescriptions have become an important complement to health and nutrition assistance programs like the Supplemental Nutrition Assistance Program to emphasize the powerful health consequences of healthy food, acknowledge the social determinants to health, and help community members manage chronic disease while lowering health care costs.2 Food-as-medicine interventions vary widely, and include cash-like supplements, produce prescription, healthy food prescription, in-kind interventions, medically tailored groceries, nontailored meals, medically tailored meals, and community garden projects. Regardless of the intervention type, some key elements can make them most successful when serving an agricultural worker population: 

  1. Center the community as you build the program and communication plan – and incorporate sufficient understanding, knowledge, and training. Engage the community to understand what types of foods their community lacks, where they prefer to receive the food and education, and what other barriers may exist. Consider in particular the values different parts of the community may hold that may inhibit their ability to receive or use food. For example, do some families who have food insecurity refuse food because they value their self-sufficiency? There is stigma around accepting free food. Do other families accept food, but discard it because they don’t know how to prepare it, or they do not want to disappoint a community leader by rejecting the offering? Are there other food provision alternatives – like providing meals at community events – that may be more successful in providing healthy, nutritious, culturally appropriate food that may overcome stigma? 
     
  2. Utilize a community health worker model with a community participatory approach. Engaging community health workers has been demonstrated to increase effectiveness of interventions of all kinds, including food security interventions. In a 2023 study, researchers provided study participants with either home deliveries of locally grown produce and shelf-stable food, or the same home deliveries of produce and food with additional support from CHWs. Eighty-one percent of those with CHW support saw a statistically significant reduction in A1C over the course of the intervention; no significant change in A1C was found in the group receiving food without CHW support.3 
     
  3. Leverage and strengthen partnerships.
     
    • Long-term connection: Community partners build trust and open doors. Many health centers built partnerships during the COVID pandemic with community-based organizations like local churches, schools, flea markets, even barber shops. These partnerships benefit from regular renewal and ongoing collaboration. This improves effectiveness of the food intervention but also sets the health center on a path for long-term partnership. 
    • Accessibility: Food producers and distributors can make it easier for their workers to access food by permitting on-site pop-ups for the intervention, as is occurring in Yolo County. Health centers can emphasize that food programs benefit their businesses by reducing illness and health care costs. 
       
  4. Take into account disaster response. Food programs should be built for ongoing, long-term engagement and support of the community. One way to strengthen the program is to consider potential disruptions or changes in community needs as a result of a disaster like a flood, extended heat wave, significant storm, wildfire/smoke event, etc. Transportation, distribution location, air quality, food spoilage, and staffing are some of the aspects of the program that may need to shift in the wake of an emergency. Watch MCN’s archived webinar, Emergency Management, available in English and Spanish, for more information: https://www.migrantclinician.org/webinar/emergency-management-2023-11-09.html
     
  5. Weave in education that is accessible in terms of literacy and cultural context. Agricultural workers can engage in and be more receptive of the project if they understand why their clinicians are prioritizing food as medicine and how it will benefit their health. This includes trainings on rights and eligibility for people of all immigration and health statuses. 
     
  6. Connect with other food programs outside the area to network with regional food hubs, which seek to connect regional farmers with local consumers. Learn more about regional food hubs in the resource, “Regional Food Hub Resource Guide,” created by the USDA Agricultural Marketing Service: https://www.ams.usda.gov/sites/default/files/media/Regional%20Food%20Hub%20Resource%20Guide.pdf
     
  7. Train health center staff. For produce prescription programs, the Centers for Disease Control and Prevention highlight additional key components, including staff training in the following areas. Read their entire guide, “Components of Fruit and Vegetable Programs”: https://www.cdc.gov/nutrition/php/incentives-prescriptions/essential-components.html
     
    • Screening patients.
    • Determining program eligibility.
    • Enrolling patients.
    • Referring patients to fruit and vegetable programs.
    • Protecting patient data.
    • Tracking participation and outcomes.
    • Conducting patient follow-up.
       

References

1  Yolo Food Bank. Yolo County Food Access Survey Report. 2024. https://yolofoodbank.org/wp-content/uploads/2024/05/Yolo-County-Food-Access-Survey-Report.pdf.  

2 Volpp KG, Berkowitz SA, Sharma SV, et al. Food Is Medicine: A Presidential Advisory From the American Heart Association. Circulation. 2023;148(18):1417-1439. doi:10.1161/CIR.0000000000001182  

3 Murray M, Bridges K, Solano M, Greiner K, Woodward J. Food RX + CHW: Investigating the Role of Community Health Workers to Close the Food Insecurity Gap. Ann Fam Med. 2023;21(Suppl 1):4231. doi:10.1370/afm.21.s1.4231 

Authors

Claire

Seda

Director of Communications

MCN

Category
Streamline
Agriculture