This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

For nearly a decade, produce prescription programs have spread across Michigan, usually individually funded by philanthropic dollars. Modeled after traditional medication prescriptions, these programs enlist physicians, clinics, health care systems, and social services agencies to write prescriptions their clients can use to obtain free, fresh fruits and vegetables. Now, efforts are underway to better coordinate efforts between these programs and to create more standardized funding mechanisms for them.

For income-challenged Michiganders living with chronic diet-related conditions, such as diabetes, heart disease, or hypertension, produce prescription programs not only frame eating well as "doctor’s orders." They also pay for a prescribed amount of fresh produce over a given period. Many of the state’s produce prescription programs also offer educational activities about food, cooking, gardening, and other nutrition topics. 
Doug CoombeParticipants in Washtenaw County's Prescription for Health program can exchange these tokens for free farmers market produce.
"It almost all starts with our diet," says Dawn Opel, chief innovation officer and general counsel for the Food Bank Council of Michigan. "With produce prescription programs, we can start to have a more holistic conversation around the prevention of chronic disease and be able to show with evidence how we can mitigate those risks and those conditions."

About 10 years ago, the Michigan Farmers Market Association (MIFMA) recognized produce prescription programs as a crucial element of connecting residents to fresh, healthy, locally grown food. Food insecurity and access to nutritious food are key factors in many chronic diseases and diet-related health conditions. By connecting patients to their local farmers markets via health care providers and other creative partnerships, produce prescription programs work to address such conditions by increasing access to nutritious food and promoting healthy eating behaviors.

Because the state’s produce prescription programs lacked a sustainable, long-term funding source, MIFMA has led efforts to support programs more holistically through its Produce Prescription Statewide Learning Network. Launched in 2017, the network was born out of a shared desire to help produce prescription programs at farmers markets improve community health and local food systems. Network partners discuss everything from implementation, prescription redemption, and evaluation to funding and sustainability. 

MIFMA Programs Director Ashley Wenger describes the network as a way to "uplift" farmers markets, noting that about 90% of the 20 produce prescription programs in Michigan this year operate with a local food focus or partner with a farmers market.

"Here in Michigan, we have a very robust local regional food system," says Bella Pagogna, MIFMA Produce Prescription Program manager. "There is a historical connection between food access, farmers markets, and local food. Produce prescriptions really highlight that connection."
Doug CoombeProduce at the Pittsfield Township Farmers Market, where Washtenaw County offers the Prescription for Health program.
The network is the first and longest-running coalition working to advance produce prescription programming in Michigan. Currently, the network boasts a coalition of more than 200 individuals and 35 organizations — including farmers markets, farmers market managers, community-based organizations, funders, health care providers, and others interested in starting or maintaining a produce prescription program. 

"Our market managers do a lot of the advocacy that's involved with produce prescription programming in Michigan," Pagogna says. "We're very grateful for the time they're able to offer to communicate the needs and impacts that the local and regional food systems and farmers markets can have within a produce prescription program and within the food-as-medicine movement overall."

The network comes together to increase awareness about programming and its impacts; facilitate collaboration and build partnerships among programs; share measurement strategies; identify funding models; and advocate for legislative, institutional, and organizational policies that support produce prescription programs.
Doug CoombeProduce at the Pittsfield Township Farmers Market, where Washtenaw County offers the Prescription for Health program.
In 2022, the network published a comprehensive report on the state of Michigan's produce prescription programs. Wenger says the report "really has brought awareness to the diverse programs that are operating." Last year, the network built upon that awareness by hosting a Legislative Education Day in Lansing, where network members were invited to meet with their senators and representatives to discuss produce prescription programs and their impact.

"Since the Statewide Learning Network began, we've observed an extensive growth in the number, size, and scope of programs operating in Michigan," Wenger says. "It serves as a space for connecting organizations looking to get involved with partners in their region or programs that are already operating."

Ariane Donnelly, health promotion coordinator for the Washtenaw County Health Department (WCHD), represents WCHD and its Prescription for Health program in the network. 
Doug CoombeAriane Donnelly at the Pittsfield Township Farmers Market.
"The Michigan Farmers Market Association’s Produce Prescription Network does a fabulous job in terms of keeping us abreast of all the news and all the changes," she says. "By being able to talk to programs just like ours, we can learn from each other."

Medicaid funding on the way

Another big step forward for Michigan's produce prescription programs is coming soon. Michigan will formalize a Medicaid funding structure for produce prescription programs later this year.

"This is going to be incredible for produce prescription programs across the state, especially in terms of the sustainability of these programs," Donnelly says.

One evaluation of 22 produce prescription programs in 12 states found improvements in cardiometabolic health among program participants. Modeling estimates have found that providing Medicare and Medicaid enrollees at the national level with a fruit and vegetable incentive would prevent 1.93 million cardiovascular disease events and 350,000 cardiovascular disease deaths, and save $40 billion in health care costs over 18 years. Expanding produce prescription programs among the 3.2 million Michiganders with Medicaid and the Healthy Michigan Plan could yield considerable health benefits and cost savings.
Doug CoombeProduce at the Pittsfield Township Farmers Market, where Washtenaw County offers the Prescription for Health program.
"Produce prescription programs in Michigan currently are funded solely through philanthropy, making scalability and sustainability quite difficult. Programs come and go based on a specific grant or gifts," Opel says. "This new Medicaid funding allows Medicaid-managed care plans to design funded partnerships that demonstrate return on investment and are sustainable and scalable across the state. We are really hoping that this opens the opportunity to resource more food for low-income Michiganders."
 
Estelle Slootmaker spends most workdays as a journalist and book editor. She also writes poetry and has two books underway: her great great grandmother’s memoir of childhood on Mackinac Island and a children's picture book. You can contact her at Estelle.Slootmaker@gmail.com.  

Photos by Doug Coombe.