- Need: A tangible way for providers to increase patients' access to affordable healthy food.
- Intervention: With Wholesome Rx, a fruit and vegetable prescription program, providers prescribe vouchers for patients to redeem for fruits and vegetables at local healthy food retailers.
- Results: Over 10,000 people have received Wholesome Rx prescriptions in rural and urban areas across 10 states.
The Wholesome Rx (formerly known as the Fruit and Vegetable Prescription Program - FVRx) was started by Wholesome Wave, a national program that makes fresh, locally grown fruits and vegetables affordable and available to communities. Wholesome Rx's evidence-based model offers a tangible solution to providers looking to help patients who are at risk of diet-related illness and cannot afford, or access, healthy food.
WholesomeRx has specifically benefited those living in medically underserved areas and food deserts. Participating providers prescribe vouchers to their patients to be redeemed for produce at local food retailers such as grocery stores and farmers markets. The vouchers are typically equivalent to $1 per day and help to lower the cost of healthy foods, creating incentives for a more balanced diet.
An RHIhub Rural Monitor article highlights a rural doctor in Maine who uses this program.
In 2010, several Wholesome Rx pilot projects were launched, including one in the rural town of Skowhegan, Maine. Since then, the program has become nationally-recognized, successful in 10 rural healthcare sites and Navajo Nation locations.
Wholesome Rx programs have typically been funded through private foundations like the Laurie M. Tisch Illumination Fund; however, state and federal agencies such as the U.S. Department of Agriculture have also started to invest in Wholesome Rx projects. Excitement for this new model has also created leverage for funding on local levels.
This video highlights the benefits of Wholesome Rx prescriptions from a provider, a patient, and Wholesome Wave's Founder and CEO Michel Nischan:
When a patient receives a Wholesome Rx prescription, it is typically accompanied by nutrition education from a provider, nutritionist, or dietitian. Depending upon the care needs of the patient, providers determine a schedule of checkups in order to measure their progress and write new Wholesome Rx prescriptions.
Part of this program's purpose is to empower providers with resources and tools to inspire healthier food choices in their patients. The National Nutrition Incentive Network, run by Wholesome Wave, equips new and existing prescription programs through the following services:
- Technical assistance and capacity building for practitioners to deliver high-quality, high-impact programs
- Assistance, resources, and training sessions regarding program development
- A community to network and share experiences, ideas, resources, and solutions
- Opportunities to contribute to fruit and vegetable prescription data collection and evaluation
- Opportunities to advocate for the expansion and adoption of clinic-community nutrition incentives through policy changes
To date, Wholesome Rx has achieved the following:
- Over 240 retailers have participated as redemption sites for these prescriptions
- Over 2,2824 patients have been enrolled in the program
- Over 13,000 people have received the benefits of Wholesome Rx prescriptions
- Over $790,000 in fruit and vegetable sales have been generated
- 69% increased their fruit and vegetable consumption
- 45% decreased their BMI
- 91% agreed or strongly agreed they were happier with their healthy weight or diabetes care because of Wholesome Rx
- 45% of patient households reported an increase in food security over program period
Articles highlighting the Fruit and Vegetable Prescription Program:
- Providing Patients with Access to Nutritious Food, The Rural Monitor.
- No Bitter Pill: Doctors Prescribe Fruits and Vegetables, NPR.
- Prescribing Veggies, Not Pills, New York Times.
- Take Two Apples and Call Me in the Morning, Modern Farmer.
- Veggie Prescriptions Given to Kids, Wisconsinrapidstribune.com.
- Wholesome Wave and Navajo Nation Partner to Overcome Food Insecurity in Navajo Nation, Foodtank.com.
This program is also featured as a program model in RHIhub's Food Access Toolkit.
- Winter months can make fresh produce hard to come by, especially as farmers markets are closed. Because of this, some locations extend their program over winter months by partnering with other local healthy food retailers.
- Skepticism leads some local food retailers to be hesitant about participating. Convenience stores may also be hesitant to participate since the majority of their profit comes from packaged foods.
- Keeping the price of fresh produce low is difficult in some locations where cost is driven by wholesale food distributors.
- Some patients who are eligible for Wholesome Rx prescriptions do not want to be associated with a program that is related to obesity and other diet-related diseases.
- Develop strong partnerships with healthcare organizations, local food retailers, farm businesses, local government, and community organizations.
- Identify program "champions" who are capable of motivating staff and dedicate adequate time to designing and implementing the prescription program.
- Design a program to work within existing healthcare, clinical practices, and retail practices to limit administrative staff time and healthcare expenses for participants.
- Ensure that the program is designed so that participants can easily access redemption locations by walking, cycling, or using public transportation. If possible, choose retail sites where participants are able to redeem prescription incentives multiple times per week, or during more convenient hours of the day and week.
- Consider including those without diet-related diseases in the Wholesome Rx program so as not to deny healthy food access to those who could greatly benefit from the prescriptions.
Food security and nutrition
Arizona, California, Connecticut, Georgia, Maine, Massachusetts, Minnesota, New Mexico, New York, Rhode Island, Texas, Utah
March 24, 2016
Date updated or reviewed
June 4, 2018
Suggested citation: Rural Health Information Hub, 2018. Wholesome Rx [online]. Rural Health Information Hub. Available at: https://www.ruralhealthinfo.org/project-examples/897 [Accessed 25 October 2020]
Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.