Understanding Fruit and Vegetable Programs

What are fruit and vegetable programs?

Voucher incentive programs for fruits and vegetables provide vouchers, coupons, or cash incentives to consumers to use at the point of purchase. These vouchers can be physical, such as paper or wood coins, or electronic, such as loyalty or debit cards.

Incentives may be redeemed at participating food pantries, farmers markets, brick-and-mortar or online grocery stores, and mobile markets. Vouchers may also be used in community-supported agriculture (CSA). A CSA enables people buy a subscription or "share" of a farm's produce. This allows growers and consumers to share the risks and benefits of food production.

Produce prescription programs allow health care workers to prescribe fruits and vegetables to patients who meet specific criteria. Such patients might be those who have chronic diseases and lack access to nutritious food.

Produce prescriptions may be used in health care settings, local farmers markets, brick-and-mortar or online grocery stores, or mobile markets. Patients also typically receive vouchers to buy produce or receive produce.

Do these two programs need to happen together?

A fruit and vegetable incentive program may operate independently of a produce prescription program. However, most successful produce prescription programs also have a fruit and vegetable incentive component. This is because the health provider often writes a fruit and vegetable incentive that reduces or eliminates the cost of produce for the patient.

Which fruits and vegetables should be included?

The Dietary Guidelines for Americans identifies fresh, canned, frozen, and dried fruits and vegetables as essential parts of a healthy diet. When designing or implementing these programs, consider:

• Cultural preferences for certain foods.
• Unique medical needs that affect food choices.
• Nutritional value of the food.
• Environmental and community impact of where food is obtained.

Community members frequently identify fresh fruits and vegetables as hard to access. Including fresh produce in fruit and vegetable programs can support local growers by connecting community members to their local and regional food system.

Canned, dried, and frozen fruits and vegetables are often more widely available, less expensive, and have a longer shelf life than their fresh counterparts. Therefore, these forms can also be promoted alongside fresh fruits and vegetables. Encourage providing options that do not include unhealthy ingredients such as added sugars, sodium, and certain fats.

What community food sites can work with these programs?

Food sites are places where individuals participating in fruit and vegetable programs can purchase or obtain fruits and vegetables. A variety of food sites may be part of these programs. They can include:

• Charitable food systems, such as produce distribution sites and food pantries.
• Food retail sites, such as supermarkets, grocery stores, farmers markets, mobile markets, convenience stores, and corner stores.

Site selection should include community input. Also consider the site's capacity to stock high-quality, affordable, and culturally preferred produce. During the selection process:

• Select sites with diverse staff from the priority communities being served.
• Consider partnerships with food businesses owned by members of the community.
• Ensure that the site will meet the needs of community members most at risk of food and nutrition insecurity.
• When possible, choose sites that are easy and safe to get to by walking or public transit.
  • For example, determine whether the program refers patients to community-based sites versus providing food at a clinic or hospital.

What are some common challenges?

Community members may be skeptical of new programs because of previous experiences with other efforts to improve food access.

It is therefore important to develop fruit and vegetable programs with community input. Ways to incorporate equity in all aspects of work include:

• Ensuring diverse recruitment and equitable pay of staff from priority populations.
• Providing training, such as equity and trauma-informed approaches, to staff and partners.

Additional operational challenges include:

• Addressing stigma, such as that of participation in these programs.
• Preventing confusion about eligibility or concerns about participation.
• Addressing information technology (IT) issues such as:
  • Availability of electronic benefits transfer (EBT) equipment at point of sale (POS).
  • Incorporation of incentive redemption systems, payment systems, and electronic medical record systems where applicable.
• Incorporating medical coding of screening, diagnosis of food insecurity, and payment for these programs. Keep in mind that not all insurers pay for these foods.
• Supporting business processes of participating retailers such as training needs and throughput needs of cashiers, IT systems, facilities for cooking classes, and more.

What resources are available?

Strategies for Fruit and Vegetable Voucher Incentives and Produce Prescriptions
Includes potential state and local activities, more resources, and examples of what others are doing.

Rural Produce Prescription Toolkit
Practical, user-friendly guide for planning and operating produce prescription programs in rural areas. Includes framework, steps to consider, and considerations for program scaling and sustainability.

Food Is Medicine Landscape Summary
Comprehensive summary on Food Is Medicine, interventions, and models that bridge access to healthy foods and the health care system.

Nutrition Incentive Hub
Resources on topics such as reporting and evaluation; diversity, equity and inclusion; and marketing and communications.

Supporting Food and Nutrition Security Through Health Care
Approaches that help health care systems provide nutrition, food, or resources to patients with high risk of food and nutrition insecurity.

The Community Guide Recommends Fruit and Vegetable Incentive Programs

The Community Preventive Services Task Force (CPSTF) recommends fruit and vegetable incentive programs for households with lower incomes based. This recommendation is based on strong evidence of effectiveness in reducing household food insecurity and increasing household fruit and vegetable consumption.