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Like most cities, Detroit faces specific challenges when it comes to the health of its residents. According to the 2018 Detroit Community Health Assessment published by the Detroit Health Department, 38 percent of them live in poverty — the highest of any major U.S. city. Poverty affects quality of life in a variety of ways. One of those is nutrition.
“We know that if people consume more fruits and vegetables in their diet, then there’s generally less space for some of the things that we wouldn’t want them to be eating, the unhealthier foods,” said Denise Pike, development director for the Community Health and Social Services (CHASS) Center. “We also know that if you have a limited income, taking a chance on something you don’t normally eat can be daunting.”
Pike helps lead the FreshRx (read Fresh Prescription) Program, a network of Detroit health care providers, local growers, food access organizations, academics, public health professionals and community development agencies. Its goal is to bridge the gap between what Detroiters eat and how it affects their health status. To do this, FreshRx prevents disease and promotes healthy choices through a three-stage system: program implementation, food access and education.
FreshRx is now in its sixth year. Patients in the program this year are given up to $90 for fresh produce, which they can purchase at one of the FreshRx market sites. According to FreshRx, approximately half of participants reported increasing their fruit and vegetable consumption, while 28 percent reported lowering their unhealthy food consumption and 21 percent reported lowering their unhealthy beverage consumption.
“Giving them the fruit and vegetable prescription and then talking with them about the food, how to select it, how to use it and how to store it really gives them a risk-free opportunity to find out which fruits and vegetables they love, so that when they go to spend their own limited resources, they already know they like it,” said Pike. “That’s the premise behind FreshRx; let’s give people a stipend, an easily accessible place to shop, teach them how to use fruits and vegetables, and show them through a tasting that it’s really delicious. That’s what we do every week.”
Pike, whose background is in urban planning, worked to develop CHASS’s latest facility seven years ago. She never left.
“I was led to FreshRx because I personally am passionate about nutrition and food and using food to fuel your body in positive ways,” she said.
Measuring Success
Chinyere Uju-Eke began working for the Henry Ford Health System — one of the nation’s leading health care providers — in 2013. As a community health educator and coordinator, her job is to foster healthy behavior changes among residents of Detroit neighborhoods. Through the FreshRx network, she provides program orientation, outlines expectations, offers education, connects patients with other health educators and dietitians, distributes program grants and completes program and participant evaluations.
Many of the patients at Henry Ford are diabetic or prediabetic, and seek help managing their weight or meeting the requirements for gastric bypass surgery. To accomplish these goals, Uju-Eke and her team teach about the components of a healthier diet, like portion and serving sizes, the daily recommended amount of fruits and vegetables, and how frequent consumption of sugary, salty and fatty foods can negatively impact their health.
“Patients are often concerned because they don’t know how to use these foods, or they don’t want to buy them because they know that they will go bad more quickly,” said Uju-Eke. “We teach them how to make modifications to their lifestyles; how to enjoy food and flavor without using sugar, salt and fat; and how to read food labels correctly, so they understand how much of these types of ingredients they’re consuming.”
But following nutritional advice will only take patients so far. This is why Uju-Eke puts in extra effort when it comes to managing expectations and success.
“We teach them how to measure success,” she said. “Patients will often say something like, ‘I’ve been eating this way for six weeks, and I haven’t lost any weight, so I’m not successful.’ When we ask them to describe success, weight loss is usually where they focus. But there are lots of ways to measure success, and that’s where we try and refocus them, on the things they experience a difference in. Maybe they’re sleeping better, or they recover faster or they’re experiencing fewer headaches. That’s success, too.”
Uju-Eke finds fulfillment in what she does because Henry Ford and FreshRx empower her to affect the health and wellness of people.
“At one point, I wanted to go into medicine to help people and make a difference,” she said. “I’m not a medical doctor, but I still have that opportunity to make an impact, to empower people and teach them how to go on and empower others. We focus a lot on community support, so we encourage people to take what they’re experiencing and share it with others the way that they know how.”
The Power of Food and Community
Once patients receive their stipend, it’s off to one of the FreshRx market sites to fill their prescription. Patrice Brown is the food access manager at the Detroit Eastern Market, a public market that’s existed for nearly 130 years. In recent decades, the Eastern Market has put a special effort into improving food access, building up the economies in its community and district, and helping local entrepreneurs become fully fledged businesses.
The Eastern Market became a full partner of the FreshRx network in 2013. At first, it was just a food vendor, but eventually it became the first to test the FreshRx food vouchers. Now, it’s expanded and even offers a mobile market, CHASS Mercado, every week to improve food access capacity.
Brown said that in the past year, the Eastern Market and its partners have pooled their resources to create a consistent nutritional program that is delivered at each service location. They’ve also been able to expand their educational offerings.
“We have a team of fellows every summer that staff the markets,” said Brown. “They’re trained on nutritional education. We partner with Wayne State University’s Dietetics Department and the Detroit Health Department so we can bring our education into something unified. We’re looking forward to growing that and sharing it with our food and health fellows so they can share it with the customers that shop and the FreshRx participants.”
Brown thinks this educational component not only teaches program participants how to work with new, healthier foods but also restores an older tradition of how people feed themselves.
“I get to feed people really good food, man,” she said. “That’s changing their life, and not just changing it for something new, but reminding them of things they might have been doing when they were brought up by their parents and grandparents; 20, 30, 40 years ago, they were gardening in their backyards and using those fruits and vegetables to preserve, and they were buying seasonally — all of those things that we just kind of forgot to think about along the way as life was happening. But food can bring us back to reality and remind us that our environment is very important in the growth of our nutrition. That is why I do what I do.”
The Eastern Market’s efforts are holistic, in that they aren’t only focused on programmatic outcomes; they make a special point to emphasize the social aspects of the Market as well.
“We bring together all cultures and creeds — we’re a true community space,” said Brown. FreshRx’s ties to community cannot be understated.
For each site to recruit patients, there must be a clinical home. Many of these clinics are found in the communities they serve.
“That’s where we get 50 percent of our patients,” said Uju-Eke of her site, Henry Ford. “A lot of these health systems are literally in the middle of neighborhoods. There are homes across the street and schools nearby. The FreshRx Program is especially essential because it shows that health systems like CHASS and Henry Ford do more than just provide standard clinical care. CHASS and Henry Ford are places people can go to find community support, find enrichment programs and make connections with people who can support behavior changes.”
No Slowing Down
FreshRx is an objectively successful program, but no one in the network is resting on their laurels. There’s work to be done and plenty of opportunity for FreshRx and the people it serves.
“We want to have more sites across the city,” said Pike. “We’d like to be a city-wide network, but what we really want is to have sustainability. Most of the programs are through grant dollars, so we are engaged in efforts to make FreshRx part of a health insurance program. For CHASS, we’d love to find a way to make this part of our standard of care so anyone who needs it gets it.” She continued that the network’s success would be measured by its growth and adoption by health plans to increase access for families across the city.
“We’ve been able to get the attention of a lot of folks that think of food as medicine in the food system; in particular, we’ve gotten the attention of a big health insurer here in the Midwest,” said Brown. “We’ve been able to get them to the table and listen to what this program has done and what we’re about. Our goal is to have FreshRx be a covered benefit. CHASS has seen the A1C levels (blood test for Type 2 diabetes) of some patients drop significantly. We know this program works, and that’s the reason we stick with it and keep trying to improve what we’re doing. We are impacting some of those diabetic patients across the board.”
It’s results like these that motivate contributors like Brown to keep FreshRx moving and growing.
“One story that was shared at a network meeting is that at Henry Ford, one patient’s A1C (diabetes test, normal range is between 4 and 5.6) was 12.1 when they started the program,” said Brown. “When they came back from their three-month check up, they had an A1C of 7. It touched my heart to know that’s the impact this program is having. I’m excited for what’s to come.”
