A few times a week, Katie Macomber, medical home care coordinator at Amherst Pediatrics, writes a “prescription” for patients and their families.
Macomber is not a doctor, and the prescription is not for medicine. Rather, it is a form from the Amherst Survival Center, designed to look like a prescription, that sends families to the center to pick up groceries, diapers or fresh produce from the food pantry, eat a free hot lunch or dinner, or get help applying for food stamps.
Amherst Pediatrics asks patients on a screening form if they have experienced food insecurity and has posters around the office telling patients to talk to a doctor if they struggled to afford food in the past year.
“Socioeconomics are such a huge part of overall health,” Macomber said. “You can’t focus on medical health if there are other issues impacting that family’s ability to care for their medical health.”
Macomber said “prescribing” food at a medical practice “really helps put it under the umbrella that this is all part of your medical health and well-being.”
The Amherst Survival Center’s Project HungeRX is part of a growing movement statewide to treat food as medicine.
On Tuesday, the Center for Health Law and Policy Innovation at Harvard Law School, and Community Servings, a nonprofit that cooks and delivers medically tailored meals to sick people at home, released the first Massachusetts Food is Medicine State Plan.
The plan examines the importance of programs that deliver medically tailored food, that provide vouchers for fresh produce and that offer healthy food to people who cannot easily access it.
One 2019 study by researchers from the University of North Carolina, Massachusetts General Hospital, Community Servings and elsewhere found that medically tailored meals were associated with fewer admissions to hospitals and nursing homes and a reduction in health care costs. A report by Children’s Healthwatch and the Greater Boston Foodbank estimated that food insecurity in Massachusetts leads to $ 1.9 billion in avoidable health care costs annually.
Sarah Downer of the Center for Health Law and Policy Innovation, one of the authors of the Food is Medicine plan, said the goal is to develop steps to change the state’s health system to better connect individuals with food and “set up pathways to build better overall community health.”
The report was released as the public is becoming more conscious of the need for healthy food, with farmers’ markets and buy local campaigns. MassHealth, the state’s Medicaid program, recently adopted a new structure in which some money will be available to address social factors that affect health.
In interviews, the researchers found that health care insurers and providers said they were interested in addressing food insecurity but many were unsure how to integrate that into medical care.
The report lays out multiple ways to integrate food and health care, such as by having doctors screen patients for food insecurity and by training health care providers about the importance of nutrition and about what resources are available to patients.
The report envisions connections between community-based nutrition organizations, like food pantries, and health care providers. It also envisions an increase in funding — through reimbursement from health insurers and other sources — for programs that offer medically tailored meals, mobile farmers markets, food vouchers and other nutrition services.
The report identifies 26 high-priority areas with a particular need for food services, including Agawam, Chicopee, Holyoke, North Adams, Pittsfield, Springfield and West Springfield.
Experts say the biggest barriers to people buying healthy food tend to be cost and transportation.
David Waters, CEO of Community Servings, said during a panel discussion on the report’s release that his organization, which was started during the HIV/AIDS epidemic, has been talking about the need to treat food as medicine for 30 years, but no one would listen. “Nutrition is the poor stepchild of Western medicine,” Waters said.
It has only been in the last four or five years, Waters said, as people were looking for new innovation in health care, that “an old innovation rose to the top.”
Maryanne Bombaugh, president of the Massachusetts Medical Society, said doctors increasingly recognize the importance of social factors, including nutrition, in health. But, she said during the panel discussion, “There’s definitely a need for education. Most of us in medical school get very little education on nutrition.”
In Western Massachusetts, there are programs already underway — and hoping to expand — to treat food as medicine.
“What we see is that food insecurity is linked to lots of different health conditions, so that people who have faced food insecurity for a significant duration of their life actually have higher rates of high blood pressure, higher rates of obesity, higher rates of heart disease and chronic illness, and reduced lifespan,” said Lev Ben-Ezra, executive director of the Amherst Survival Center.
Ben-Ezra said the center is partnering with doctors who see patients struggling to buy food but may not know where to send them or how to raise a delicate issue.
Jeff Harness, director of community health and government relations for Cooley Dickinson Health Care, said people used to think of a hospital solely as a place to go for surgery or to treat a broken bone. “But when you think about health care today, it’s really much broader than that,” he said.
Harness said health care systems are increasingly realizing that people have social needs that affect their health — like access to healthy food, employment and transportation. “There’s just a lot of things that are outside of the role of the health care system traditionally and yet we know that our communities and our patients are deeply influenced by their day-to-day access to those sorts of things,” he said.
Cooley Dickinson has been partnering with community-based organizations to support nutrition programs. It funded an Easthampton program to grow vegetable gardens at schools. It helped establish a free ride program for hilltown seniors. It partnered with Grow Food Northampton and Healthy Hampshire to support a mobile market that sells fresh produce at reduced rates.
Clem Clay, executive director of Grow Food Northampton, said the mobile market brings food from local farms to six Northampton neighborhoods and provides subsidies for low-income residents to participate in a farm share, which is delivered via the mobile market.
“We’re making it affordable and convenient for low-income populations to get healthy local food,” Clay said.
The organization is not targeting populations based on health yet, but Clay said it hopes to expand if MassHealth money becomes available to reimburse organizations that subsidize healthy food for patients.
“There’s nothing to me that revolutionary about the idea that eating good food is good for your health, and that’s really the core of it,” Clay said. “The problem is the way our food system is designed, the way income inequality in our society manifests, that’s a very difficult thing to achieve.”
Caitlin Marquis, coordinator for Healthy Hampshire, said the Northampton mobile market last year conducted around 200 transactions and had 26 shareholders picking up weekly farm shares.
Healthy Hampshire and other organizations recently got a grant from Attorney General Maura Healey’s office to create a new mobile market serving the hilltowns. It is developing “prescription pads” similar to those used by the Amherst Survival Center where community health centers and clinicians can refer patients to the mobile market.
Marquis said the goal is to reach people who are unable to get fresh produce easily — whether because of price, transportation or disability.
“We know from conversations with a lot of residents who are facing those challenges that really what matters to them is being able to get a source of fresh healthy food right there in their backyard,” she said.