Every Saturday, she goes to the farmers market near her home in South King County. This Somali woman, who asked not to be named, buys seasonal pears and plums and ingredients for a traditional Somali dish, maraq baamiye, with spinach, onions, okra, tomatoes and spices.
The money she uses to purchase the locally grown produce comes from an unusual pilot program called Fresh Bucks Rx, which allows doctors to write a prescription, backed by cash vouchers, for fresh fruits and vegetables from farmers markets.
The program was created to improve the health of low-income people with diet-related diseases.
The program is also supposed to put a dent in food insecurity, or the inability to access healthy food daily. The Somali woman and her husband suffer from diabetes and are clients at Harborview Medical Center.
Harborview and the Odessa Brown Children’s Clinic launched Fresh Bucks Rx with the city of Seattle and Seattle and King County farmers markets late this summer. The Washington State Department of Health provided funding with a four-year statewide grant from the USDA Food Insecurity Nutritional Incentive, known as a fini grant.
One August morning, the Somali woman visited Harborview to see Ben Atkinson, the manager of outpatient nutrition, to learn more about the program. Like many patients who qualify for Fresh Bucks Rx, she and her family can’t afford to live in Seattle.
“Do you know about the farmers market in Des Moines that’s in the program now?” Atkinson asks, through an interpreter. “It’s pretty close to you and right down by the waterfront.”
The woman nods, smiles and says “good” in English. There’s light laughter while Atkinson writes her a prescription for fresh fruits and vegetables.
Some 30 farmers markets are participating in the pilot, which builds on Seattle’s successful Fresh Bucks fruit and vegetable access program. The original Fresh Bucks began five years ago in communities around the country and provides a dollar-to-dollar match — up to $10 per day — of food stamp or snap benefits at participating farmers markets.
Atkinson says his clients appreciate the extra money because food prices keep rising while their benefits stay the same: “I can’t tell you how many diabetic patients we’ve worked with or people trying to lose weight where they say, ‘I’d love to eat an extra apple a day or buy a head of broccoli but I can’t manage that. A box of mac n’ cheese or top ramen is much cheaper and that’s gonna fill me up more.’”
Clients such as the Somali couple often acquire the diet-related diseases this program targets when they come to the United States, Atkinson said. Grocery stores dominated by junk food and ultra processed sugary products replace culturally and nutritiously rich food traditions, especially when the processed food is cheaper. Gone too, in many cases, he says, is physical activity people engaged in regularly at home, such as walking or farming.
“They come to the U.S. and that is not the culture to say the least,” Atkinson said.
Anti-hunger advocates began to join forces with farmers market coalitions in the 1970s to find ways for low-income people to get healthy food. A hunger epidemic and loss of land for small farms brought them together, said Kathleen Fitzgerald, a consultant on federal food and farm policy.
They argued that if small farms could grow organic food for the entire U.S. rather than solely for those who could afford the higher prices, demand would grow and costs would fall. Over the decades that followed, advocates lobbied the USDA to link nutritious food programs for low-income populations with support for local small farms.
Fast forward to today, and money for nutrition-related programs represents close to 80 percent of all programs in the 2014 Farm Bill, Fitzgerald said, the most recent year the bill was authorized.
The Farm Bill should really be called the “Food Bill,” advocates say, because it determines everything from what kids will eat for school lunch to how surplus agricultural commodities will be dispersed, especially feedlot beef and dairy products. The 2014 Farm Bill allocated $76 billion for snap and $22 billion for child nutrition programs.
The USDA authorized close to $100 million for the FINI grants between 2015 and 2019. The Washington State Department of Health and more than 60 multi-sector partners won the grant worth $5.86 million. It’s the largest fini grant in the nation, said Amy Ellings of the USDA. As a result, farmers markets issued almost $160,000 fruit and vegetable incentives to snap customers so they could afford more fresh, locally grown fruits and vegetables. More than 99 percent of the money allocated was spent on fruit and vegetables, Ellings said.
All families who participate receive between three to six months of Fresh Bucks Rx.
In a country of excess, food insecurity is a social injustice, says Dr. Ben Danielson, clinic medical director at Odessa Brown Children’s Clinic. Fresh Bucks Rx is an equity measure, he said.
“A lot of families are just plain old hungry or at least can’t access healthy food and are forced to make dire choices,” Danielson said. Anything society can do to break cycles of marginalization and poverty is the right thing to do, he added.
Local farm Clean Greens grow veggies of all kinds on land they rent in Duvall. The farm sells outside the Odessa Brown Children’s Clinic every Saturday. They also set up a table at Harborview three days a week. Born from the energy of folks who attend the Central District’s New Hope Baptist Church, the mission of Clean Greens is to sell at prices people can afford. Now that Fresh Bucks Rx is up and running they’re selling almost everything they put out on the table, said Lottie Cross, farm stand manager.
One woman came down and “just went crazy buying” because her husband had a medical diagnosis that required fresh veggies. Clean Greens had it all: kale, collards, cabbage, turnips, carrots, mustard greens, leeks.
“She was so excited about it, you know,” Cross added, “and that’s what we’re about. Making people happy to eat healthy.”
It seems like a simple recipe that food insecurity advocates hope to replicate for some time to come.