Doctors are taking a new approach to get to the root cause of some costly illnesses.

(This article by Fenit Nirappil originally appeared in the Washington Post.)

Adrienne Dove pulled up to the checkout line of the Giant grocery store in Washington with a cart filled with cabbage, bananas, and bagged string beans. The register rang $20.60. Instead of cash or card, Dove paid with a Produce Rx voucher from the store pharmacy. The Giant in the most impoverished part of the District of Columbia is the latest frontier in the “food as medicine” movement.

Hospitals and  local governments across the country have been writing and filling prescriptions for healthy food in an attempt to address the root causes of diabetes, hypertension and other costly illnesses. The federal farm bill that was passed late last year included more than $4 million in grants for the U.S. Department of Agriculture to distribute to governments that run prescription produce programs, but the money has not yet been distributed.

The goal, backed by some research, is to improve health and reduce costs by subsidizing fresh produce such as broccoli and grapefruit in addition to insulin and beta blockers. “What we are hoping to find is there is a return on investment for the health-care system: a reduction in ER visits, medication compliance,” said Lauren Shweder Biel, executive director of DC Greens, a nonprofit group that is managing the District’s Produce Rx pilot. “That’s the holy grail for systems like this.”

Improved diet is also a target.

“I was trying to manage my patients’ diabetes and high blood pressure, but when they were telling me they were eating Top Ramen, doughnuts, and bagels because it keeps them full, all I could say was ‘That’s too bad, here’s some more drugs,'” said Rita Nguyen of the San Francisco Department of Public Health, who oversees an expanding produce prescription program.

In the nation’s capital, the Produce Rx program provides 500 Medicaid patients $20 weekly vouchers for produce at the Giant in Ward 8 through the end of the year. Ward 8 is the poorest, sickest part of the city and has the highest rates of death for diabetes and heart disease. It’s also a food desert, and the Giant is the only full-service grocery store.

The Produce Rx program, which includes the cost of vouchers and evaluates patient outcomes, has received $500,000 from the District government and about $150,000 from American Health Caritas, a Medicaid-managed care organization. Dove, 43, found out about the pilot program at a health clinic. Medical professionals often urged Dove to eat better, but she was surprised when a clinic official called the grocery store pharmacy to secure produce vouchers for her the same way doctors would call in a prescription for drugs. “I grew up on McDonald’s and I got high blood pressure,” she said. “Now I tell my son, ‘don’t be like Mommy,’ and he asks for broccoli and spinach.”

One of the biggest challenges for programs is ensuring that access to healthier foods will make a difference in what a person chooses to eat. Ciera Price was on her first shopping trip after her doctor wrote her a prescription for the produce program when she met the supermarket’s in-house nutritionist, Jillian Griffith, and scheduled a free consultation. “When they tell you to eat healthy, what does that mean to you?” Griffith asked Price. Price winced. “Leaving everything that I love and sticking to the greens.” Griffith offered a more optimistic answer. “Maybe you can learn to love new things,” she said. “We want to be in the middle and mindful of the things we are eating and how to eat foods that make us happy.”

In 2001, Boston Medical Center launched one of the first food pharmacies with its food pantry in the basement of the safety net hospital, which treats patients regardless of their ability to pay. Nguyen said proponents are still trying to figure out the best way to set up such programs. “We don’t know what dose of food is enough to make a difference,” Nguyen said. “Is food by itself enough? Or do you need the nutritionist, do you need the cooking supplies, the recipes?”

In Pennsylvania, the Fresh Food Farmacy initiative by regional health insurer and provider Geisinger provides produce, cooking demonstrations and diabetes management lessons to 700 patients. In the first two years of the program, officials found that diabetics who received food saw their blood sugar levels decline, as opposed to those who were not given any. Allison Hess, a Geisinger executive, said the Fresh Food Farmacy costs about $3500 per family annually, and drops in blood sugar would result in greater savings from less medication. “It’s kind of a no-brainer,” Hess said. “We are going to either pay for this medical expense or pay for this food and education that’s going to be more of a lifelong benefit.”