Hippocrates wrote “Let food be thy medicine and medicine be thy food.” St. Christopher’s Foundation for Children (SCFC) has taken that mantra to heart with its FreshRX program. An outgrowth of the Foundation’s award-winning Farm to Families food program launched in June 2010, FreshRX empowers local physicians to use fresh food as a tool to combat the adverse effects of poor nutrition. FreshRX disrupts the traditional medical mindset by offering doctors the chance to hand out an entirely new type of prescription—one for apples, carrots, broccoli and a whole host of farm-fresh foods.
Launched in June 2010, St. Christopher’s Foundation for Children’s Farm to Families (F2F) initiative was originally established to address the issue of inadequate access to healthy food in North Philadelphia. The concept—a modified community supported agriculture (CSA) program relying on numerous community partnerships to offer boxes of farm-fresh, wholesome foods at wholesale pricing on a year-round basis—was born out of internal strategic planning along with community needs assessments demonstrating that North Philadelphia families had extremely limited or no access to fresh, healthy food. If fresh food was available, it was often cost-prohibitive, especially compared with the highly subsidized, processed alternatives.
FreshRX takes Farm to Families one step farther by recognizing and responding to the specific health and psychosocial impacts of both a poor diet and food insecurity, including increased illnesses and hospitalizations, poor attention and academic performance and, especially troubling, a significantly higher risk of depressive disorders and suicide attempts.1
St. Christopher’s Foundation for Children serves an eight-zip-code section of North Philadelphia2. The community comprises more than 300,000 residents, over 67 percent of whom are minority.3 More than 46 percent are living on incomes of below $25,000 a year, and more than 30 percent of residents are children under 18.3 In addition, as many as 67 percent of children are overweight or obese depending on the specific zip code.4 Almost two-thirds of adults reported consuming less than the daily requirements of fruits and vegetables, while more than half reported eating fast food at least once a week.4
St. Christopher’s Foundation for Children launched its Farm to Families initiative in response to this high incidence of hunger and food inequities in North Philadelphia. The goals are to provide increased and improved options to healthy food so families can improve their health and well-being, to teach families about healthy eating through practical, engaging food education and to create policy changes at the city and state level to further increase access to healthy, nutritious foods.
Working with an extensive network of community partners with the SHARE Food Program as its hub, Farm to Families supplies North Philadelphia families with weekly boxes of produce at a cost of only $10 (medium box) or $15 (large box). Each box is filled with fresh fruits and vegetables, usually valued at double the purchase price. Additional a la carte items—including local eggs, meat, and seafood—are also offered at affordable prices. Cash, credit and SNAP benefits are all accepted for payment.
Strategic partnerships are the bedrock of the Farm to Families initiative. Over the lifetime of the program, more than 18 organizations5 have played a role in the development, implementation or evaluation of the program. These include community-based organizations, schools and universities, health institutions and evaluation and policy consultants. The Farm to Families initiative is a true multi-field collaborative, creating new partnerships and strengthening existing ones. SCFC is using the expertise and capacity of individuals and institutions to create a new model—one that not only goes far to help hundreds of North Philadelphia families eat healthier and live better, but also is replicable and scalable to meet the needs of other at-risk communities.
Since its inception, Farm to Families has directly touched the lives of more than 1,100 North Philadelphia families, helping them to access wholesome foods to improve their health and well-being. Setting its roots within community-based organizations has enabled Farm to Families to create a personal environment that goes beyond food access to actively support and encourage healthy behavior changes. Farm to Families itself has evolved substantially as understanding of the issues has deepened. For example, increased access to healthy foods only addresses tip-of-the-iceberg issues. Effective nutrition education and long-term behavior change are critical. As a result, Farm to Families has shifted its emphasis from strictly food access to a focus on improving health through nutrition.
FreshRX: The Evolution and the Revolution
As Farm to Families began to expand its reach within North Philadelphia, it was natural to build on the existing relationship between St. Christopher’s Foundation for Children and St. Christopher’s Hospital for Children. Founded in 1875, the Hospital serves over 30,000 children in its North Philadelphia neighborhood through its various outpatient programs, which include a Healthy Lifestyles clinic for children who are overweight or obese and the Grow Clinic for children with failure to thrive.
Hospital administration recognized the value of the Farm to Families program for the Hospital’s patients and agreed to serve as one of six community-based distribution sites. As SCFC worked closely with Hospital personnel to launch the site, it became clear that physicians were eager to have a tool to help their patients who were struggling. It’s easy to tell patients to improve their diets, but without the ability to prescribe a particular medication or therapy regimen, physicians may inadvertently add to some of their patients’ challenges, especially those who already struggle with access to healthy foods.
As one physician, Dan Taylor, D.O., commented, “We see young patients everyday who are undernourished and underweight or, at the opposite extreme, overweight and obese. Growing numbers of children are exhibiting iron deficiency, anemia and Type 2 diabetes. Serious cognitive effects also accompany poor nutritional habits, from shortened attention span to irritability, fatigue and difficulty with concentration. Fresh food is a wellness-critical resource that, if introduced early, can help correct certain ills and chart a path for a healthy future.”
Enter FreshRX. With Farm to Families as an on-site resource, it was logical to take the next step and empower St. Chris doctors to begin referring their patients to the program. But a verbal referral didn’t seem powerful enough, so SCFC created a special “prescription” pad so that physicians could actually prescribe the program to their patients. Designed to look like traditional prescriptions, thanks to funding from Shire Pharmaceuticals, the FreshRX prescription serves as a coupon for a five-dollar discount on a patient’s first purchase.
Building on the special doctor-patient relationship, FreshRX enables Farm to Families to combine authority with accessibility and helps to strengthen the patient’s understanding of the connections between nutrition and health. Jan Shaeffer, executive director of St. Christopher’s Foundation for Children, explains: “FreshRX enables physicians to prescribe fresh food in the same way that they would prescribe medicine. And further, doctors can direct children and families to an affordable, year-round food-share program with sites right at the hospital and in their neighborhood.”
In the first year of FreshRX, physicians at St. Christopher’s Hospital wrote 484 prescriptions, of which 26 percent (126) were redeemed. Although the redemption rate is significantly lower than the overall average prescription fill rate within a Medicaid population (78 percent filled),6 this is not surprising with a non-pharmacological prescription. Most prescriptions, 66 percent, were written from the general pediatrics clinics. An additional 34 percent were written from the 12 subspecialty clinics that began issuing prescriptions over the course of the start-up year. In the upcoming year, the Hospital staff plans to undertake a more comprehensive evaluation of the FreshRX program including the impact of the messaging. Plans are also underway to expand FreshRX to additional health centers within North Philadelphia.
Education and change within food policy have been consistent components of the Farm to Families program. SCFC has partnered with The Food Trust to focus on issues such as sidewalk vending of fruits and vegetables as part of the Healthy Corner Store Network and to offer education to Farm to Families partners around critical food policies. Currently, the two organizations are partnering to create a North Philadelphia Food Policy Coalition.
However, FreshRX has expanded and deepened the opportunities for policy change beyond food access and into healthcare. In June 2012, SCFC convened more than 125 national and regional thought leaders, policy change advocates and insurance professionals together with practitioners working in the field to increase awareness of food inequity and its impact on health, while highlighting the results of innovative responses. This day-long symposium marked the beginning of a dialogue about long-term policy changes that are necessary in order for food and nutrition to be incorporated as key components of medical care. Although some changes, such as shifts in how nutrition is considered in medical training or fundamental changes in how food and nutrition services are covered by insurance, may be disruptive to current practice, they hold potential for deep impact. As FreshRX expands and grows, it provides the opportunity to generate a body of evidence to support these potential paradigm shifts.
Farm to Families and FreshRX provide a valuable lesson on the importance of both partnership and evolution in the development of new initiatives. As originally conceived, the mission of Farm to Families was to create increased access to healthy foods in a low-income, low-food-access community. By learning from its partners and being open to ongoing evolution, the program has broadened its goals and deepened them to encompass improved health and preventative care. By collaborating with the healthcare community, St. Christopher’s Foundation for Children has taken a vital step toward total health integration, directly connecting food and nutrition to medical care.
Ann Hoskins-Brown is program director for St. Christopher’s Foundation for Children, where she develops and manages the Foundation’s programs and initiatives, including the Community Oral Health Initiatives, the Farm to Families nutrition program and designated fund grantmaking, while working to identify needs and evaluate options for new mission-aligned initiatives. She collaborates with staff and board to set strategic direction, create and/or oversee the creation of program plans and evaluations and provide technical assistance to applicant organizations and grantees. She has presented the Foundation’s Farm to Families initiative at the American Public Health Association’s national conference and is scheduled to present at the Grantmakers in Health national conference in March 2013.
In 2010, St. Christopher’s Foundation for Children was awarded an Innovation Partnerships Prize from the United Way of Southeastern Pennsylvania for its Farm to Families initiative.
1) "Childhood Food Insecurity." Oregon State University. http://oregonstate.edu/instruct/dce/chi/module4_2.html (accessed December 26, 2012).
2) Service area comprises zip codes 19120, 19122, 19124, 19125, 19133, 19134, 19137 and 19140.
3) Courtesy: PolicyMap
http://www.policymap.com (community custom report generated September 29, 2011)
4) Public Health Management Corporation's Community Health Data Base 2010 Southeastern Pennsylvania Household Health Survey
http://www.chdbdata.org (accessed December 26, 2012)
These selected findings are from Public Health Management Corporation's (PHMC) 2010 Southeastern Pennsylvania Household Health Survey, a major telephone survey of more than 10,000 households that examines the health and social well-being of residents in Bucks, Chester, Delaware, Montgomery and Philadelphia counties. The survey is conducted as part of PHMC's Community Health Data Base, which contains information about local residents' health status, use of health services and access to care. PHMC is a nonprofit public health organization committed to improving the health of the community through outreach, education, research, planning, technical assistance and direct services.
5) The Farm to Families program’s past and present partners: 11th Street Family Health Center, Common Market, Community Partnership School, Esperanza Health Center, Girard College, Greensgrow, Health Promotion Council, Neighborhood Bike Works, New Kensington CDC, Norris Square Neighborhood Project, OMG Center for Collaborative Learning, SHARE Food Program, St. Christopher’s Hospital for Children, Sunday Suppers, The Food Trust, The Lighthouse, The Reinvestment Fund, University of Pennsylvania/PennPraxis, Women’s Community Revitalization Project.
6) "Unfilled Prescriptions in Pediatric Primary Care." Pediatrics. http://pediatrics.aappublications.org/content/early/2012/09/19/peds.2011-3480.full.pdf+html (accessed December 26, 2012).