It’s about 40 degrees Fahrenheit in the colder of the two warehouse storage rooms at the Local Food Hub, and the air smells of cardboard and brown paper, of bell peppers and root vegetables, and the earth that grew them. Boxed bushels of apples—which keep for months when refrigerated—sit on tall industrial shelves. Printed in bold red letters on the side of each apple box is a proposal, an instruction: Eat Virginia apples.

It’s a sound suggestion. As the popular aphorism goes, “an apple a day keeps the doctor away,” and there’s certainly truth to the saying, as a diet rich in nutrient-dense fruits and vegetables can beget better health.

But an apple a day isn’t enough for total health—there’s more to it than that. And, for some, a single apple, even one grown on a tree at an orchard just down the road, is difficult to come by.

This is the type of thing that Local Food Hub food access fellow Nathan Wells thinks about as he drops 248 crisp green Granny Smith apples into 62 brown grocery sacks on a chilly mid-October morning, packing up CSA-style shares that he’ll distribute later in the day to area clinics as part of Fresh Farmacy, a fruit and vegetable “prescription” program that’s cultivating a healthier Charlottesville by addressing both food access and public health issues in the community.

Every two weeks, from about mid-April through late November, Local Food Hub, a nonprofit organization dedicated to increasing community access to local food, sources, packs and distributes 203 bags containing around $30 of locally grown organic produce, all at no cost to the recipients of the groceries. This particular week, in addition to the four apples, Wells adds to each bag one pie pumpkin, two large delicatta squash (the edible skin softens when the squash is roasted), a box of baby spinach, three green bell peppers, two bunches of leafy collard greens and two heads of broccoli. Upon peeking into a box of broccoli, Wells pauses—it looks a little yellow, ready to spoil.

This broccoli isn’t good enough for the bags, he says—it won’t last for more than a day or two, and he’s unwilling to give nearly spoiled broccoli to someone who might store it in her refrigerator and return a few days later to a rotting, inedible vegetable. Because in Wells’ eyes, that piece of broccoli is more than a dinner side dish roasted in the oven per the recipe included in the Fresh Farmacy bag; it’s potential for a better life.

“Food is a cornerstone of health, friendship, culture and community. It brings people together around something we all share,” says Wells. What’s more, “food is medicine. If you can eat good, clean food, you’ll have more energy, get sick less often, spend less time out of work or at the doctor’s office. You’ll be able to work more, support yourself and your family better,” he says. This, too, is something Wells thinks about when he packs the Fresh Farmacy bags: Healthy people equals a healthy community.

A simple equation, right? Not entirely, because not everyone in our community has access to healthy food. According to Map the Meal Gap, in 2015 there were 7,630 food insecure people in the city of Charlottesville. That’s 16.9 percent of the city’s population without reliable access to sufficient amounts of nutritious food.

Food insecurity manifests in a variety of ways. Some people live in food deserts, where there are no nearby markets that carry fresh foods. Others face transportation barriers that either make it extremely difficult or prevent them from getting to the grocery store—if you take three different Charlottesville Area Transportation buses to get to Kroger, you take three buses home with your heavy groceries in tow (and what if it’s hot, raining or snowing outside?). Others have to choose between shelter and food, and they opt to pay rent before buying food. Still others may not know how to prepare and eat, say, a butternut squash or an avocado, and spend their food dollars instead on something more familiar and perhaps less nutritious.

Limited access to food can be a barrier to health, says Tish Polgar-Bailey, a psychologist and nurse practitioner at Charlottesville Free Clinic. Most of her patients have chronic medical conditions such as diabetes, hypertension and high cholesterol and are either overweight or underweight—all of these conditions can be both better managed and prevented by good nutrition, she says.

But telling someone to eat better isn’t enough, she says. Oftentimes, primary care providers instruct their patients to adopt a better diet without considering whether that patient has access to those healthier foods. “It seems on some level disingenuous to tell people what to do and then not also help them get what they need in order to follow through on those instructions,” says Polgar-Bailey.

And so, for the past three years, the Fresh Farmacy program has enabled care providers at three local clinics to essentially prescribe produce to their patients. As Wells says, food is medicine.

Access granted

Inspired in part by other produce prescription programs, such as the ones in New England piloted by nonprofit food access organization Wholesome Wave, Fresh Farmacy launched its pilot program in 2015 with funding from the Centers for Disease Control and Prevention’s Preventative Health and Health Services Grant (which also provided funding for Harvest of the Month, another Local Food Hub program focused on food education for school-age children).

It seemed a dream come true, says Elizabeth Beasley, former health promotions consultant for the Thomas Jefferson Health District. She and others had noticed that after a social marketing initiative encouraging people to track their fruit and veggie intake, the health department had to be more mindful about food access and education in the community. Beasley and Erika Viccellio, a former director of the Charlottesville Free Clinic, often daydreamed of programs they’d implement if money were no object. One of those dreams was to enable doctors and nurse practitioners to write prescriptions for healthy food. When the CDC funding opportunity came up, they brought the idea to Lisa Reeder, food and farm access coordinator, and Kristen Suokko, executive director, at Local Food Hub, as well as health clinic folks they knew through the health district’s Move2Health initiative and the Food Justice Network, and set out to see if a produce prescription could work in Charlottesville.

The health district secured the funding, Local Food Hub sourced the food, and three clinics chose the first set of people to receive the produce prescriptions, which at first were even written on small Rx pads.

Each of those three clinics serves a slightly different population: The Charlottesville Free Clinic provides access to general medical, dental and mental health care, as well as prescription medications, for uninsured and underinsured people in Charlottesville and Albemarle County; the Sentara Starr Hill Health Clinic, a free wellness center run by Sentara Martha Jefferson Hospital, tackles obesity—a rising public health concern—through a variety of wellness programs for children, teens and their families; the Westhaven Nursing Clinic provides care for residents of the Westhaven public housing complex, including families and the elderly.

Most of the patients at these clinics face financial and other barriers to food access, and the clinics selected (and continue to choose) Fresh Farmacy participants by considering those who are undernourished or at risk for diet- and lifestyle-related diseases such as diabetes, obesity, hypertension and coronary heart disease, and those who are ready and willing to make a change in eating and wellness habits.

People have the opportunity to meet with a care provider when they pick up the bag, and during the pilot year, the clinics tracked patient biometric data closely. Over the course of the 28-week distribution cycle, patients saw biometric improvements, such as weight loss or gain (some people started the program undernourished and/or underweight), improved body mass index, better blood pressure control and blood sugar control. Just about everyone reported feeling generally better, too.

The program was well-managed and well-received, Beasley says, and after that first year, the health district handed the management of Fresh Farmacy over to Local Food Hub, which now handles both the food and funding side of things while allowing the clinics, which best know the individual needs of their patients, to organize bag distribution.

“I don’t know anybody that wouldn’t want for one of those bags of groceries,” says Barbara Yager, a nutritionist and health and wellness consultant at City of Promise, an organization committed to improving educational outcomes and quality of life for families in Charlottesville’s 10th and Page, Starr Hill and Westhaven neighborhoods (the Westhaven public housing complex was built in 1964 to house residents of Vinegar Hill, a historically black neighborhood, which the city razed to build the Downtown Mall area). City of Promise currently manages and distributes the Westhaven Nursing Clinic Fresh Farmacy shares.

“It’s very high-quality food; it’s not leftover food, it’s not robbing food, it’s not marginal food,” Yager says of the produce, and that’s an important component of the type of food access Fresh Farmacy provides. When Yager began working in Charlottesville public housing areas in the 1980s, she frequently saw food delivery trucks coming into neighborhoods and “literally dumping pallets of white bread products on the sidewalks for residents and driving off.” She also saw food banks giving out food—salty, sugary, preservative-laden nonperishables like white bread, Twinkies and Marshmallow Fluff—that caused more medical problems than they helped. “I’m sure they were thinking they were giving hungry people food,” she says, but the practice was very demeaning. “It’s sort of like, this is the food you would serve somebody less than you, and it’s not what you would serve your family,” she says.

Yager says that a single bag of produce can be a catalyst for all kinds of things, not just an individual’s good health. “It’s giving something of value to people as a statement that they’re valued, their lives are valued. [It’s] the excitement of something new, the excitement of discovery, the excitement of teaching their children, of learning a different way of cooking,” of sharing recipes and dishes with one another in their apartments and during church potlucks. Three of the families served by Westhaven’s Fresh Farmacy program are Karenni persons from Burma, and during community cooking classes in the City of Promise kitchen, they’ve showed Yager and others how to cook with the roots of greens, something not typically done in American cooking.

Each Fresh Farmacy share also comes with a simple, easy-to-read recipe on how to prepare at least one of the bag’s ingredients with common kitchen ingredients, like the oven-roasted broccoli with olive oil, oregano, salt and pepper, which Wells included in each bag. The recipes and accompanying write-ups about, say, suggestions for when to use curly kale and when to use dinosaur kale, help familiarize people with new ingredients.

For May Belle, an 89-year-old Westhaven resident who’s lived in the neighborhood for 45 years, the Fresh Farmacy dropoffs remind her of the late Holly Edwards, an activist, parish nurse for the Jefferson Area Board of Aging and former vice mayor of Charlottesville who died this past January. Edwards helped bring the Fresh Farmacy program to Westhaven back in 2015, but May Belle knew her long before then. May Belle, who uses a wheelchair to get around, lives alone in a small apartment decorated with a painting of San Francisco, a picture of former President Barack Obama and dozens of framed family photos—she has four children and more grandchildren, great-grandchildren and great-great grandchildren than she can count. “Every time you turn around there’s a new one,” she says with a laugh. Edwards often stopped in to check on May Belle and take blood pressure and blood sugar readings; sometimes those visits resulted in trips to the emergency room, and May Belle is convinced that Edwards saved her life more than once.

Other visits were calmer, like the time Edwards taught May Belle how to pickle beets. Now, whenever May Belle gets beets in her Fresh Farmacy bag, she pickles and cans them and thinks of Edwards. “I miss her,” May Belle says. “She was a beautiful person. She was just…she was good.”

One of May Belle’s neighbors or a City of Promise staff member delivers her bag on Fresh Farmacy dropoff day, and May Belle usually invites them to sit in her living room to chat—about growing up on a farm out in Stony Point, about the best way to soak pinto beans before cooking them, about dating in this day and age—before she unpacks her groceries. “I can get the fresh vegetables that I don’t have money to buy, for free,” she says of the Fresh Farmacy share. “And then what I don’t eat, I prepare and put in the freezer, in freezer bags, so I don’t have to cook all that at one time,” she adds. Once while looking into the sack that Nathan Wells had packed up earlier that morning, she spotted collards and told City of Promise check and connect coach Chris Burton, who delivered her bag that day, about her favorite way to prepare them (de-stemmed and soaked in some lightly salted water before sautéing).

Fresh Farmacy isn’t just about the collards; it’s about the community.

Community outreach

In 2017, two other area clinical programs—UVA Health System’s employee wellness program, BeWell, and Region Ten’s Boost integrated care program, funded by a federal grant through the Substance Abuse and Mental Health Services Administration—joined Fresh Farmacy, which more than doubled the size of the program: By the end of the year, Local Food Hub will have distributed 29,500 pounds of food (up from 11,865 pounds in 2016), worth nearly $52,000.

This amount covers 203 bi-weekly shares; 30 shares each to Westhaven and the Free Clinic; 35 to Starr Hill Health Clinic; 90 to BeWell and 18 to Region Ten’s Boost program. The Westhaven, Charlottesville Free Clinic and Starr Hill Health Clinic sites are funded by grants obtained by Local Food Hub from United Way, MLG Foundation, Dominion, Bama Works and a few anonymous donors; BeWell and Region Ten pay for their own shares.

Region Ten, which joined the Fresh Farmacy program in late summer, will test out a winter pilot program to see if and how Fresh Farmacy might be sustained for all sites through the colder months.

People miss the shares in the winter, says Lisa, a Westhaven resident who has participated in Fresh Farmacy since the beginning and uses her share to cook for four people, including her two young grandchildren. She says that when she goes to the grocery store, she’s often disappointed by the price of produce—it’s a lot of money for a little bit of food, she says. And while the City Market is both walkable from her home and a fun place to discover new vegetables and fruits, it’s expensive. (C-VILLE priced out the bag of produce that Wells packed up—the one full of squash, apples, spinach, collard greens, broccoli, peppers and a pumpkin—on a recent Saturday at City Market, and the total came to more than $48.) At one point in her life, Lisa wouldn’t eat for days because she had neither the time nor the energy to cook for herself. But she loves fresh fruit and vegetables, especially tomatoes, and when she has no-prep-needed snacks like carrots and bell peppers around, eating well is less work. Plus, she says, it’s important to her that her grandchildren learn healthy eating habits when they’re young, like snacking on vegetables and dip instead of cake.

Lisa’s neighbor, Lorrie, was involved with Fresh Farmacy in a previous season and hopes to get back on the list soon. She says the program introduced her to some items like squash and broccoli that she might not have tried otherwise. Oftentimes, Lorrie walks to the City of Promise house with Lisa to retrieve a share for an older neighbor who has trouble walking.

It works out well for the farmers, too. Ashley and Daniel Malcolm run Malcolms Market Garden, a 10-acre vegetable and flower farm on Christian’s Creek in Staunton. “We farm because we love the dirt,” Ashley says. “We love nature and the science and challenge of growing food for our family, neighbors and community,” and raising a family “in a healthy, satisfying, humble and honest way.” Because Malcolms is a small farm, it might not be able to supply enough produce to sustain, say, a University of Virginia dining hall’s needs, but it can certainly contribute to the smaller-demand Fresh Farmacy shares. Before the growing season, Local Food Hub and 25 of its partner farms work out how much of a certain item the Fresh Farmacy program will require, and when. When the produce is ready, Local Food Hub buys it direct from the farmer and brings it to the warehouse, where Wells performs his bagging ritual.

Jamie Barrett, a farmer at the 1,000-acre Bellair Farm just outside of Charlottesville, says that the Fresh Farmacy program sustains “the whole chain,” paying farmers a fair price for their product while supplying it to the consumer at a low (in the case of Fresh Farmacy, free) price and showing the consumer how to use and enjoy the product. It “really dovetails with [Bellair’s] goals to get local food out to different segments of the population,” Barrett says. Nationally, there seems to be a movement toward putting better food in our bodies, and that’s a choice that all people should have, he says.

Healthy outcomes

Anecdotal evidence and numbers alike suggest that Fresh Farmacy is contributing to a healthier Charlottesville. At the end of the 2016 season, Local Food Hub held a focus group to ask Fresh Farmacy participants about their experience with the program. Ninety-five percent said that they would eat more fruits and vegetables in the future; 63 percent said they would eat local produce in the future, but Local Food Hub believes that the number could be higher if participants felt as though local produce were accessible to them outside of the Fresh Farmacy program.

In that same focus group, 88 percent of participants said they felt as though Fresh Farmacy was improving their eating habits, but more people—91 percent of the participants—felt that Fresh Farmacy was improving their overall health. This could be evidence for the idea that healthy eating spurs more healthy activity and jump-starts general wellbeing. This is something that Rita, one of the Free Clinic patients, has discovered. Once Rita started eating more produce, she says she started to feel better and picked up another healthy habit: taking a four-mile walk every morning. She frequently shows up to the Free Clinic Fresh Farmacy pickup wearing sneakers, patterned workout pants and a T-shirt with “Fitness 4 Life” printed across the chest.

 

The Free Clinic’s Polgar-Bailey believes, too, that there’s something to be said for showing someone that you care about them as a person, about their entire being and not just numbers on a scale and lab test results. Sharing food often means sharing culture, sharing personal stories, which is a surefire way to get to know someone.

Another of Polgar-Bailey’s patients, a woman named Virginia, starts talking of food as soon as she sees bunches of curly kale poking out of the tops of the bags, a lively contrast against the Free Clinic’s drab beige walls. Virginia, who has high blood pressure, high cholesterol and diabetes, enrolled in Fresh Farmacy last year and says that not only is she feeling well, she says that the pickups conjure good memories of growing up in the Mexican countryside. In Spanish, she tells Polgar-Bailey that when she was a child, she’d visit a street with produce stands on either side, tables full of onions, peppers, chiles, lettuces, cilantro and more, and people could just take what they needed. That doesn’t exist here in the United States, Virginia says as she sits in a waiting room chair with her bag of produce in her lap, rubbing the kale between her index finger and thumb and thinking of how she’ll prepare it later.

Next year, Local Food Hub plans to continue funding 95 shares for the Starr Hill Health Center, Westhaven and the Free Clinic; so far, United Way and MLG Foundation have committed to helping fund the program, which will cost about $60,000 for those 95 shares, says Local Food Hub’s Reeder. Local Food Hub hopes to secure enough funding to expand the program to one or two additional sites, perhaps to the Southwood neighborhood in Albemarle County, which is currently being redeveloped by Habitat for Humanity.

Region Ten and BeWell, whose involvement more than doubled Fresh Farmacy’s reach in 2017, hope to participate in 2018 as well.

Because Fresh Farmacy is entirely grant and donation funded, there’s no way to guarantee its existence year to year. Charlottesville has too many resources for people to be left out of the local food narrative, says Jackie Martin of Starr Hill Health Center. “I wish as a community we’d invest more money in programs like Fresh Farmacy, because we know that people have better health outcomes when they eat healthy,” Martin says. She worries that free, fresh produce won’t be around forever, and wonders what we as a community will do to ensure that Fresh Farmacy continues and expands, both for the veggie consumers and the farmers.

“We are healthiest in relationship, in community,” says Polgar-Bailey, and Fresh Farmacy sustains community. “Health is not a possession. It is not mine to have, if I am fortune enough to have it, and to keep it for myself, but a gift to be given and nurtured in others. …If we try to guarantee health only for some, we corrupt it. Health, individually and in the broader sense—in the community—grows when we help provide for it and nurture it in others.”