By: Kelsey Long, Project Policy Analyst for the Center for Vulnerable Populations in the Division of General and Internal Medicine at Zuckerberg San Francisco General Hospital
We are told from a young age to eat our fruits and vegetables, yet poor diet is the leading cause of death in the United States. Over $500 billion a year is spent in the U.S. treating chronic diseases, many of which are mostly preventable by diet and moderate exercise. Yet, for many people in America, food insecurity, or the lack of consistent access to adequate food for a healthy life, is a significant challenge and makes it more difficult for many to meet the nutritional needs of their household.
“As a primary care provider, patients would tell me that they really wanted to eat a healthier diet, but foods like fruits and vegetables were luxury items and they simply didn’t have enough money to afford them. That was really the impetus for starting EatSF.”
– Hilary Seligman, Vouchers 4 Veggies – EatSF Founder, Primary Care Provider
Providing Diverse Communities With Affordable Veggies
Since its launch in 2015, the Vouchers 4 Veggies – EatSF (V4V) team has been working alongside community-based organizations and clinics to provide fruit and vegetable vouchers to low-income San Francisco residents. The V4V program experienced significant growth in its six years, becoming one of the largest fruit and vegetable supplement programs in the nation with a consistently long waitlist. The program is optimized to meet the needs of diverse communities and has been successfully replicated in both urban and rural settings across the nation, including Cumberland, VA, Boulder, CO, and Los Angeles.
The program is simple. V4V provides participants, enrolled by partnering organizations like local clinics, with between $20 and $40 a month for 6-9 months in fruit and vegetable vouchers, which are redeemable at partnering grocery stores, farmers markets, and corner stores.
Reducing economic barriers to fruit and vegetable purchases can support healthy dietary intake and address the root cause of many chronic diseases. The V4V program helps participants afford healthy food and improves food security. V4V participants consistently report an increased fruit and vegetable consumption of approximately one serving per day, enough for immediate health impacts. In addition, 39% of participants report increased food security while on the program.
Vouchers 4 Veggies has become one of the largest fruit and vegetable supplement programs in the nation with a consistently long waitlist.
Supporting a Shift to Preventative Care
With the rise of the ‘food as medicine’ movement and the increased understanding of how the experience of food insecurity increases the risk of poor health outcomes and health care utilization, the V4V program is well situated to help healthcare providers offer a resource to their patients and support a shift to preventative care.
V4V participants feel better, improve management of chronic diseases, and reduce the need for costly medical care. Programs that address food insecurity can have a significant impact on health care utilization and costs. In fact, while the mean cost of one hospital admission for someone with diabetes who experiences low blood sugar costs an estimated $1,386.80 per patient, it only costs $120 to provide fruit and vegetable vouchers to that person for six months.
“I was able to stop taking my blood meds due to me eating more fresh vegetables.”
— Program participant with high blood pressure
Vouchers support the individual needs of each participant. Participants can use their vouchers at vendors that are convenient for them and select foods that meet their family’s personal and cultural needs. V4V is good for the community, driving money into the local economy. Since 2015, V4V has infused over $1.5 million in fruit and vegetable purchases into underserved neighborhoods.
A recent study estimates that for every dollar spent at partnering vendors, an average of $2.1 is contributed to the local economy — an estimated $3.15 million throughout the life of the program! When V4V participants use their vouchers, money is infused directly into the local community, generating income and jobs in the agricultural and food retail sectors.
Since 2015, V4V has infused over $1.5 million in fruit and vegetable purchases into underserved neighborhoods.
Utilizing Tech to Combat Higher Pandemic Food Insecurity Rates
The COVID-19 pandemic made life harder for everyone, but particularly for those already struggling to make ends meet. Not surprisingly, food insecurity rates in the U.S. have significantly increased over the past year. Additionally, the closure of restaurants, along with increased demands to stock pantries and fewer trips to the store has increased the prices of many food items. According to the San Francisco Chronicle, fruits and vegetables have seen some of the largest year-over-year increases in the Bay Area, increasing by 12.2% in December 2020 from December 2019.
The pandemic exacerbated the need for food support in the Bay Area and beyond, yet also complicated the delivery models of many food assistance programs, making them unable to fully meet growing food insecurity in San Francisco. The V4V program was optimized to respond flexibly during the COVID-19 pandemic. The V4V Salesforce database, which utilizes Nonprofit Success Pack and was built in partnership with a consulting team at Swift River Consulting, helped the V4V team to streamline and adapt services for remote implementation.
The database enables online enrollment of participants and tracking that simplifies remote voucher distribution and allows for real-time, bi-directional communication with partnering organizations. What was once a burdensome manual process for staff has now become an automated process that frees up hours of crucial staff time. Now when participants are enrolled through our online site portal, we immediately have contact and enrollment information available, giving us a critical touch point with our participants, allowing us to track enrollment progress for each site in real time.
In addition, this immediate access to contact information enables us to send reminder texts to nudge participants to use their vouchers or offer nutrition education information to encourage participants as they choose to incorporate healthy lifestyle changes. It also helps us to more readily assist when technical assistance needs arise.
In the short term, this solution has improved the efficiency of our program and allowed us to adapt our program for healthcare settings where processes have to be quick and easy for providers. In the long term, it’s helping us to better suit our program for rapid scaling and optimize it for replication in hard-to-reach populations across the country
Read more about tech-focused solutions to combat food insecurity.
About the Author
Project Policy Analyst for the Center for Vulnerable Populations in the Division of General and Internal Medicine at Zuckerberg San Francisco General Hospital
Kelsey Long is a Project Policy Analyst for the Center for Vulnerable Populations in the Division of General and Internal Medicine at Zuckerberg San Francisco General Hospital. She works with Dr. Hilary Seligman and the Vouchers 4 Veggies – EatSF team to support projects and research related to food security and health. Kelsey previously worked as a high school mathematics teacher in San Francisco’s Mission District where she observed first-hand adolescent food insecurity and poor nutrition. Kelsey holds a BA in Mathematics from the University of Texas-Austin and an MPH in Public Health Nutrition from UC Berkeley.
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