We've long been inspired by the "Rx" approach – healthcare providers writing prescriptions for fresh fruits and vegetables that low-income families can redeem as vouchers at local farmer's markets.
Last month we invited Michel Nischan, CEO & Founder of U.S.-based organization Wholesome Wave, which pioneered the Rx approach in the States, to talk about strategies and successes for this program and others in a webinar called Filling the low-income plate: How Wholesome Wave is shaking up preventative health and the future of food security. He told us that the best way he's found to impact policy and make lasting change in the health of low-income communities is to "shed the anger," and push through obstacles collaboratively with doctors, community organizations, and government.
We asked Michel Nischan to share his thoughts on how to increase access to healthy food in low-income communities, how to scale up engagement, and what inspires him.
1. Why do we need to subsidize healthy food for low-income people?
For people struggling on low incomes, unhealthy food is sometimes the only affordable choice. A lot of it is also heavily subsidized. Subsidizing fruits and vegetables levels the price playing field and creates the conditions to meaningfully shift a low-income person’s decision toward a healthier food choice.
The subsidies that favour unhealthy food production came into being after WWII as a way of accomplishing two important things: 1) Food security from a national security perspective and; 2) Non-perishable food that was light and easy to transport. Both of these approaches to national security, seasoned with the powerful notion of ending world hunger, presented a compelling argument to use public dollars to significantly shift our agriculture and food production models. The problem today is that a small number of companies are making a lot of money perpetuating these systems. That’s going to take time to change.
2. You’ve recently received some big investments from a few quarters. How will this expand and change your work?
As we strive to scale, we need to engage larger-scale supporters from government and private foundations or corporations, at a financial and supply chain perspective. This allows us to uncover, experiment, and invest in innovations that will allow us to go from reaching hundreds of thousands of low-income consumers, to reaching millions.
To put it into perspective — a lot of people have congratulated us on the success of getting fruit and vegetable incentives into the Farm Bill. The Food Insecurity Nutrition Incentive Funding is $100M, and requires an equal private-sector match. So all-in, the field is capable of reaching hundreds of thousands of people, rather than many millions. We’re not going to see meaningful impact on public health, and its costs, until we’re reaching at least 10 million Americans. With 45 million Americans relying on SNAP and an additional 21 million who are food insecure, we’ve got a lot of work to do. These scaled relationships will help us get closer.
3. In order to get at the root causes of poverty and food insecurity, what kind of policy changes are you pushing for from government?
We're looking at levers that will greatly increase the ability of low-income consumers to afford to make healthier food choices. We’re pushing to strengthen the incentives approach as well as basic SNAP benefits in the Farm Bill. But we have an eye on the Affordable Care Act and Medicare and Medicaid policy as well. The top diet-related diseases just in direct costs are over $216 billion a year. Snap is $70-$80 billion a year. So the the cost to treat diet-related disease is almost three times the SNAP budget.
The healthy foods capable of preventing or mitigating these diseases cost far less than drugs or medical treatments, like dialysis, amputations, or organ transplants. To invest in food in the front end, and reduce costs in back end, constitutes a program that can pay for itself.
However, this doesn’t address the root cause of poverty. Poverty is the lack of money. In the U.S., that has come to mean under-employment and under-payment for those who are working full-time jobs. We won’t solve poverty until we see incomes rise for jobs that used to actually pay people enough to avoid poverty. The vast majority of people in the workforce are making and cleaning things. Those jobs used to pay enough so people could own a home and have one car. Now those jobs won’t even put food on the table.
4. As a chef, what do you recommend to working on the front lines get people excited about cooking and healthy eating?
As a chef, obviously I’d like everybody to be excited about healthy eating and cooking in general. If you have a basic knowledge of culinary techniques and seasoning — there isn’t a whole food out there, whether a fish, animal or plant, that can’t be made delicious. The true barrier is being able to afford the healthy ingredients that basic culinary techniques will make delicious.
When I started as a chef, I thought it was all about education and teaching people. I was wrong. For people struggling with poverty, the barrier to eating healthfully is not knowledge or education. Affordability is the barrier. You can pour money into teaching healthy cooking — but if people can’t afford fruits and vegetables, they’re not going to buy, cook, or eat them. It’s that simple. I believe in power of knowledge, but it’s meaningless if the person you’re teaching can’t afford it.