The Fruit and Vegetable Prescription initiative will promote affordable access to fruit and vegetables and promote healthy food options.
Describe your relationship to the place you’ve selected.
Cornell Cooperative Extension (CCE) of Albany County is a leader in providing research and evidence-based nutrition education to low income, limited-resource families throughout the Capital Region, with the goal of reducing the incidence of childhood obesity and alleviating chronic disease. For over 50 years, trained nutritionists have provided education to low-income families with children in the Capital Region through the Expanded Food and Nutrition Education Program (EFNEP) and the Eat Smart New York (SNAP-Ed program).
CCE Albany County SNAP-Ed proposes to serve a region consisting of Albany, Fulton, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, and Washington counties. The poverty rate in the region ranges from 6.6% – 19.6% with the highest rates of the nine counties found in Montgomery and Fulton, both falling above the NYS average poverty rate of 15.1% and a national rate of 14.6% (Figure 1 attached). Montgomery and Fulton Counties also have the highest rates of children in poverty (29.6% and 23.4%) and the highest percentage of households receiving SNAP (19.9% and 15%) -- as does Washington, Schoharie, and Schenectady County households at 14.6%, 13.9% and 13.8% respectively (Figure 2) (NYS Poverty Report, March 2019). The remaining counties we propose to serve fall closely behind, indicating that there is a need for additional nutrition education and obesity prevention in this region. Within the nine counties, there are hot spot areas, which fall below the county poverty line (Table 1, attached). Hot spots most often correspond to low-income schools and by identifying these neighborhoods, we are able to focus on meeting the greatest need.
Describe the People and Place: Provide information that would be helpful for an outsider who has never been there and may have no context about this Place to better understand the area.
Throughout SNAP-Ed’s nine-county region, 61,958 households receive SNAP benefits, representing 112,446 people; 60% of those SNAP recipients live in, Albany, Schenectady, and Rensselaer Counties. In the Capital Region, an estimated 270,410 individuals are food insecure (OTDA, 2019). Rates of children that are food insecure are highest in Albany (12%), Fulton (11.9%) and Montgomery (11. 6%) counties (Map the Meal Gap, 2017). Demonstrating consistency with county NYS Community Health Indicator Reports (CHIRS), which shows Albany, Fulton, and Montgomery as the counties with the highest percentage of people reporting a lack of reliable access to food within the past year. These counties also face high food insecurity rates between 8.8% - 13.1%, with the majority just below the state average of 12.6% (U.S Census, 2018). Households with children showed an increase in food hardship from 17.5% in 2016 to 18.4% in 2017 (Hunger Solutions NY, 2017).
Food insecurity is linked to obesity, and rates of obesity are high among those living below the SNAP threshold. Within Albany County, 4.8% of residents, have limited access to supermarkets and large grocery stores. The percentages for Schenectady, Rensselaer, Schoharie, and Montgomery are 5.7%, 4.3%, 6.9%, and 7.9% respectively. These rates are above the NYS average of 2.49% (Food Environment Atlas, 2012). According to a study completed by Seserman and Whalen in 2011, 11,500 households in Albany County and 8,000 households in Schenectady County were located in a food desert and had no personal transportation to get to a grocery store. Households using public transportation usually have to walk far distances, making the purchase of fresh produce inconvenient or impossible, causing families to utilize corner stores more frequently due to convenience and feasibility. These corner stores discourage a healthy diet by providing limited selections of healthy foods and offering fresh produce at higher price ranges (Hunger & Food Security, May 2016). As a result, individuals living in a food desert, who do not drive or use public transportation, have been found to have higher rates of obesity (Brownell et al., 2017). The USDA’s new standards for SNAP retailers allow for more variety and produce options for SNAP participants; however, the availability of fresh produce in these stores will always be limited and comes at a higher cost. A 2008 study by Pearce and Witten further demonstrated this connection between food access and obesity by revealing that deprived neighborhoods had at least two times more fast-food outlets than in thriving neighborhoods. Moreover, ERS data from 2016 demonstrated that an increasing demand for convenience foods has impacted diet and health quality in these communities. ERS also determined that the percentage of adults that have heard of MyPlate has increased from 20% in 2014 to 24% in 2016 (ERS, 2016). However, these numbers are still low, and knowing the fundamentals of MyPlate is different than implementing needed behavioral changes. This can be difficult when there is little or no access to fresh fruit and vegetables.
Challenges: Describe the current (2020) and the future (2050) challenges that your food system faces.
Obesity levels throughout NYS point to a need for SNAP-Ed as well. Obesity is associated with adverse health, social and economic consequences, and is the primary cause of Type 2 diabetes. The prevalence of adult obesity in NYS Counties ranges from 16.9- 44.8% (BRFSS, 2016). Within the nine-county region, adult obesity rates range from 25.3% in Albany County to 40.6% in Washington County (BRFSS, 2016). All counties in this region fall above the NYS Prevention Agenda Objective of reaching an adult obesity rate of 24.2% by 2024 (CHRIS, 2018). Eight of nine counties are at or above the Prevention Agenda objective for childhood obesity of 16.4% of children with a Body Mass Index (BMI) at or greater than the 95th percentile. Whereas, in Montgomery and Schoharie county the number of children with a BMI greater than the 95th percentile increased by 6% and 2.5% respectively from 2014-2016 (NYS Prevention Agenda, 2019-2024).
An outcome of decrease access is a decrease consumption of fruit and vegetable consumption which, provides important nutrients to reduce the risk of chronic diseases, including obesity and diabetes. Only 25.7% of residents in the Capital Region report consuming five or more fruits and vegetables a day. Albany County has the lowest consumption rate, with 23.9% of adults consuming more than five servings daily (DOH, 2013-2017). In NYS the reported data for people who “consumed one or less Fruit and Vegetables per day” revealed that eight of the nine counties were below the state averages at 31.2%, and were also below the Prevention Agenda objective of 31.7% (BRFSS, 2016). The only exception was Fulton County, reporting a 33.5% (NYS Prevention Agenda, 2019-2024). As we move to the future we have to continue to meet and grow within our state and national goals. HealthyPeople.gov provides evidence-based objectives aimed at improving the overall health of the public. Every 10 years, the objectives are reviewed with the overarching goal to promote healthy people, free of disease and health disparities. To achieve health equity and promote healthy development, obesity levels in impoverished neighborhoods need to be addressed.
Address the Challenges: Describe how your Vision will address the challenges described in the previous question.
Cornell Cooperative Extension of Albany County will target SNAP-Ed eligible individuals, specifically SNAP participants, other low-income individuals who qualify to receive SNAP benefits and other means-tested Federal assistance programs, in high need priority locations throughout nine counties in the greater capital region, including Albany, Rensselaer, Schenectady, Fulton, Montgomery, Washington, Warren, Saratoga, and Schoharie Counties. Based on needs assessment data, specific efforts will be focused on, but not limited to: the city of Albany, west hill neighborhood, Cohoes, Watervliet, Troy City, Lansingburg, Rensselaer, Schenectady City, the southeast neighborhood of Amsterdam, Gloversville, areas of Mechanicville, Corinth, South Glens Falls, Hudson Falls, White Hall, and areas of Richmondville and Cobleskill. Programming will target SNAP recipients and households eligible for SNAP, their families, and other high need populations. High need populations are identified as women with children, children and youth, individuals with disabilities and seniors. Adults as well as youth, along with their parents, will be targeted in low-income areas where they live, work, shop, eat, play, and learn.
High Level Vision: With these challenges addressed, now provide a high level description of how the Place and the lives of its People will be different than they are now.
Cornell Cooperative Extension of Albany County will impact these target areas and the lives of the residents by promoting, educating, creating, and developing access to affordable and nutritious foods. These target areas have the potential to flourish economically with the introduction of local healthy food retailers while simultaneously allowing retailers to expand their customer base. Increasing the knowledge of individuals living in these communities further encourages this expansion. Participants will experience increased access to nutrient-dense foods and receive self-satisfaction from being able to provide food security for themselves and their families. Creating environments where access to food increases and is welcomed, decreases the stigma of using SNAP benefits. This also changes the cultural opinion that fresh and healthy produce options are expensive, which often creates a barrier for purchasing.
Working with healthcare providers we are able to increase access and promote healthy lifestyles, encouraging participants to see their primary care provider more regularly. By showing decreased BMI and increased healthy food sales we are able to provide evidence to healthcare providers to start the process of integrating a value-based payment. The health of the people in the community will improve as well as the clinical quality and outcomes, while also containing or reducing health care costs. Increasing the consumption of fruits and vegetables is imperative in these communities in order for them to strive. Cornell Cooperative Extension of Albany County SNAP Ed. Nutrition education can create a welcoming community hub for all patients and residents by providing USDA approved curriculum that is evidence tested.
Full Vision: How do you describe your Vision for a regenerative and nourishing food future for your Place and People for 2050?
The Fruit and Vegetable Prescription (F&V Rx) initiative will promote affordable access to fruit and vegetables and promote healthy food options. The project will pilot in three counties shown to express the overall highest need. Currently, Saratoga county has a 6.6% poverty rate with 7.9% receiving SNAP (the lowest of the 9 counties) however, the percent living in poverty with children present in the household is 25.8%. Comparatively, Albany county has an overall poverty rate of 12.4% and the highest SNAP caseload of 31.2% of those households having children living in poverty. This indicates many pockets of poverty throughout the region eligible for SNAP-Ed. Partnerships within the local community system and the built environment are crucial to enhancing these areas. In upstate NY we have access to an abundance of high-quality local food. Partnering with local Farmers Markets, farmers, food pantries, grocery stores, and community-based health centers within the targeted areas of the county will be approached and accessed using the readiness survey, to help understand partnership capacity. After acquiring MOU’s, SNAP Ed nutritionists will provide technical assistance and training to partners. Health care providers will assess participants' needs using two-question guidance. If eligible the provider will provide the participant with a F&V Rx 'prescription' which will be ‘filled’ by attending classes offered at an eligible location. Cooking Matters curriculum and Farmers Market Tours guide will be used to address state program goals. Leveraging additional resources from this grant, participants will receive one of three incentives; Fresh Connect Coupon, Healthy Food Pantry Bag, or Fruit and Vegetable voucher incentives. The ultimate goal of this program is to increase fruit and vegetable consumption, access, and increase redemption of SNAP benefits on fresh produce to achieve the goals of the NYS prevention agenda 2024 goals.
Through its first year, Cornell Cooperative Extension (CCE) Albany SNAP Ed will partner with specific Farmers Markets, food pantries, and community-based health centers within the targeted areas of the county. CCE Albany SNAP Ed will assess partners with readiness surveys to help understand the capacity and areas of collaboration partners may require before implementing this program. To plan for year-round success as well as weather permitting success, supermarket partners will also be developed to provide a secondary site for retail redemption of fruits and vegetable incentives. Working with food pantries will also help supplement year-round sustainability for produce, whether in partnership with Squash Hunger, local farms, Region Food Bank or several other local community partners. Food pantries will have separate identified “healthy bags” to provide to persons utilizing the Fruit and Vegetable Rx from their health care provider. These “healthy bags” will contain food items with low sodium, no sugar added, and whole grains. Working with our community partners, the Saratoga Pre-diabetes Coalition, Franklin Community Center, Pitney Meadows Community Farm and Saratoga Hospital Medical Group, will work together to identify the areas with the highest need in Saratoga. The Food Pantries of Capital District have formed a “Food is Medicine” Coalition, which will assist in identifying areas in Albany, and Rensselaer counties. Coalition and community partners like this will be established in each of the other counties to replicate the efforts being accomplished in Saratoga and Albany County.
The overall goal of this program is to increase fruit and vegetable consumption, access to and increased redemption of SNAP benefits including, WIC checks, EBT, Farmers Market checks, and Fresh Connect Coupons; both goals working towards the NYS prevention agenda 2024 goals. Integrating different levels of the community in the project will have a larger effect on system change. This high level community involvement may lead to policy change within organizations and/or within local health insurance companies.
To identify patients at risk for insecurity The American Academy of Pediatrics (AAP) has recommended an in-office two-items food insecurity screener. 1) Within the past 12 months, we worried whether our food would run out before we got money to buy more. (Yes or No) 2) Within the past 12 months, the food we bought just didn’t last and we didn’t have money to get more. (Yes or No) Doctors are then able to recommend this patient to see a wellness coordinator, dietician or nutritionist. Once the patient has seen one of the three healthcare professionals, they are then informed about the program and asked if they would like to sign up. Incorporating F&V Rx from the health care provider will allow participants to access a series of classes performed by SNAP Ed Nutritionist. Classes will be executed in one of three ways; farmer’s market tours, pop up grocery tours at food pantries or on-site grocery tours. Nutritionist will use material from the Farmers Market Tours; A Guide for Nutrition Educators and the USDA approved Cooking Matters Curriculum. During these tours, the Educators will provide information on eating healthy on a budget, eating a balanced diet, why consuming more fruits and vegetables are better for you, and how to navigate your SNAP benefits. Additional supportive material and ideas will come from the Wholesome Wave; Fruit and Vegetable Rx Program Toolkit. If available, the participant will receive one of three incentives; Fresh Connect Coupon, Healthy Food Pantry Bag, or Fruit and Vegetable voucher incentives. If the class takes place at a farmers market, the participant will receive a fresh connect coupon. If the class takes place at a food pantry, the participants will receive a pre-packed “healthy bag”. If the class takes place in a grocery store the participant will receive another incentive either obtained through a partnership with the grocery store or additional funds through this grant. Like the farmers market, the participant can use the incentive to purchase a new type of fruit or vegetable to try or to take home. This methodology aims to create a safe, inclusive environment that promotes and encourages healthy behaviors and empowers choice.
Using the Readiness survey, CCE Albany SNAP Ed will evaluate the potential partners during the first year, to establish meaningful connections. CCE Albany SNAP Ed will develop MOUs with farmers markets, food pantries, and grocery stores while providing technical assistance and Obesity Prevention Staff Training to partners. We will track the number of Rx from healthcare providers and class attendance. Program evaluation will happen in two parts, participants will take a post-survey assessing their intention to change behavior in regards to eating more fruit and vegetables and to identify new behaviors and information learned. Educators will monitor how incentives are distributed and how many were redeemed on site. Additionally, educators will track if other SNAP benefits were redeemed with F&V Rx incentive.
By September 30th, 2021 during the first year of the grant, partnerships within three counties will be explored through readiness surveys and identified as places to implement the F&V Rx initiative. Those three identified partnerships will carry out the missions of the F&V Rx program.
Indicators of Performance:
By the End of FY 2020:
1. Recruit and collaborate with three counties in high need areas: Rensselaer, Albany, Fulton, Schenectady, Montgomery, and Washington.
2.Establish a minimum of six MOU’s with partnerships throughout the three counties
3. Provide technical assistance and training to three partnerships.
4. Fifty percent of incentives will be redeemed during the course of the class or farmer's market tour.
5. Twenty participants from each county will utilize the F&V Rx initiative.
6. Evaluate the return on investment
Through collaboration, this program aims to connect food access, health, and local agriculture to build a food secure community and a strong regional food system.
Aim to help lower healthcare costs because research shows food insecure adults have higher chances of chronic illness and more hospital room visits.
Impact on providers:
Greater engagement with patients
Increased partnerships with community
Referrals system to outside resources
Impact on local economies:
New, repeat customers for increased produce sales
Sustainability in mobile markets and farmers markets and retail corner stores.
Community Supported Argurtual (CSA) incentive program
Shown success and sustainability:
A unique aspect of the Fruit and Vegetable Prescription (F&V Rx) initiative, a national program, is the model can be tailored to each state and location where it is implemented. The goal of the program is to increase access to fruits and vegetables and is able to be tailored to meet the specific needs of the target community. Wholesome Wave is the leader in programs focusing on prescriptions of fruits and vegetables. Their work has spanned over 46 states and their network continues to grow. In 2017 they were able to reach 973,868 people and through their funded projects they reported over $12.2 million spent on healthy produce by low-income shoppers. Using this model we hope to help expand the reach and funds put back into the community.