Thanks to one man's vision,
Fairview Hospital of Great Barrington, one of three
Critical Access Hospitals in Massachusetts, has become
known as a leader in creating progressive, nutritional
value for its community.
Roger Knysh, a
long-term employee of Berkshire
Health Systems' foodservice department, directs all
dietary activity within its affiliate, Fairview Hospital.
He has made it his mission to provide daily access to
nutritious options for patients, staff, and the
Drastic changes for Fairview began in 2006, when Knysh
signed the Health Care Without Harm's
Healthy Food Pledge on the hospital's behalf.
Fairview was the first hospital in Massachusetts to sign
the pledge, and Knysh immediately got to work
implementing its requirements to provide fresh, healthy
food for those they serve.
Roger understands that the hospital sets the tone for the
community. We take care of sick people, but in a broader
sense, we are setting a standard as a role model.
Lauren Smith, director of Community Relations at Fairview
Hospital, testifies that it has become a much healthier
place than 25 years ago when tuna fish sandwiches and
white bread were cafeteria staples. Today, their menu
features fresh Jersey milk, low-sodium soups, whole-grain
breads, all-natural beef, and recipes made with produce
from the hospital's garden. In a state that has been a
frontrunner of the farm-to-table
movement, Fairview is seen as an initiator.
“Roger understands that the hospital sets the
tone for the community,” says Smith.
“We take care of sick people, but in a broader
sense, we are setting a standard as a role
Building a Sustainable Model
After signing the Healthy Food Pledge, Knysh decided one
of the best ways to provide fresh food was by growing
their own. He constructed an on-site private hospital
garden that produces tomatoes, cucumbers, onions,
lettuce, garlic, basil, peppers, and broccoli, to name a
few. The produce is planted and harvested by foodservice
staff and used in Fairview's kitchen on a regular basis.
The 40-foot by 20-foot garden has continued to expand
every year, creating a sustainable source of fresh fruits
Wave's Fruit and Vegetable Prescription Program
(FVRx) [now called Wholesome Rx] is another program
working to create access to nutritious food for patients.
This national program, which has been implemented in 12
states and 35 rural and urban healthcare facilities,
makes fresh produce affordable for patients who suffer
from diet-related health problems. Headquartered in
Bridgeport, Connecticut, FVRx is gaining ground in
underserved areas as a simple way doctors can provide
nutritious incentives for patients. Providers can
“prescribe” nutritious food in the
form of free vouchers which are typically equivalent to a
dollar a day. The vouchers can be redeemed for fresh
produce at local food retailers. Donations and grants
from local foundations, city and state agencies, as well
as hospital investments, have been used to fund the
The Heart Healthy Lenoir Project (HHL) is a
research-based initiative intended to identify models
that make a difference in people's health. Funded by the
Lung, and Blood Institute, HHL creates resources and
tests ways to reduce heart-related problems in Lenoir
County, North Carolina. One method that has proven true
is nutrition education.
Dr. Alice Ammerman, professor of nutrition in public
health and director of University of North Carolina's
Center for Health
Promotion and Disease Prevention, has been an active
researcher for HHL. As fried food and barbecue are
favorites of many in the region, part of Ammerman's work
is developing new recipes and teaching North Carolinians
how to cook their Southern comfort foods in healthier
“Eating locally-produced food is becoming more
popular around the state,” commented Ammerman.
“The problem is that many people no longer know
how to cook from scratch, and young people have lost the
art of cooking. We try to adapt local favorites to be
healthier, showing people that they don't have to give up
what they enjoy for a healthier diet.”
HHL also helps those who can't afford nutritious food.
“Food baskets and
community supported agriculture (CSA) efforts tend to
be higher-end projects,” says Ammerman.
“We have done some work to make them affordable
for most people by cost-offsetting.”
For example, HHL has helped several veggie vans and small
farmers' markets launch in Lenoir County. To cut the
price for patients and community members, hospitals and
insurers in some areas help subsidize the cost of fresh
Going Above and Beyond
The successes of Fairview Hospital, FVRx, and HHL are
largely due to their willingness to go above and beyond
to ensure that as many people as possible gain regular
access to nutritious food.
Knysh took a big risk in 2010 when Fairview Hospital
became one of the first in the nation to remove
sugar-sweetened beverages from room service menus, staff
meetings, vending machines, and the cafeteria. The task
was not easy. At first, he experienced some push-back,
but constant staff education and support from Fairview's
administration kept the momentum going. The staff and
community have since come to embrace this change, among
Smith agrees with Knysh on the necessity of being
unconventional. “We are at a place with
hospital food where expectations are low. (Healthcare
facilities) that are changing things are going to get
that 'wow factor' back,” predicts Smith.
In Skowhegan, Maine, Dr. Michael Lambke, family practice
doctor and medical director of Redington-Fairview
General Hospital (RFGH), works hard to help his
patients fully benefit from FVRx. In order to receive an
FVRx prescription, his patients must enroll in a
six-month course developed by Lambke and his medical
team. Sessions engage patients in fun, physical, and
nutritional activities such as hula-hooping, dancing,
hiking, and cooking lessons. Community organizers skilled
in motivational interviewing are brought in to encourage
patients in their healthy adaptations. Because of this
tactile approach, “We have great retention…and
are making a significant impact not just on the child,
but also on their family members,” attests
Educating Providers and Patients
In order to educate patients on nutrition and healthy
food choices, providers themselves need to know how to
best conduct that conversation. HHL and FVRx have created
some key resources to equip providers to incorporate
nutrition discussions when treating a patient.
Dr. Tom Keyserling, professor at UNC School of Medicine and
internist at multiple hospitals in North Carolina,
contributes to HHL research. As a doctor, he describes
one of the difficulties medical providers face.
“One of the challenges of primary care is
figuring out how to convey meaningful lifestyle messages
in short office visits. After (medical care) is given,
there is not much time for lifestyle counseling. Doctors
need to have tools to use and resources to turn
to,” stated Keyserling.
This dilemma has motivated much of HHL's work. The past
few years, researchers have developed materials to make
it easier for clinicians to have nutrition discussions
with their patients. Keyserling now uses Healthy Eating
Materials, Healthy Lifestyle Tips, and other HHL tools
during office visits.
As FVRx is moving into more underserved territories, FVRx
Senior Program Manager Amanda Morgan recognizes that
rural providers know the challenges their patients face
as well as the best solutions to their health problems.
“They are in a unique position to help their
patients understand the connection between the food they
are eating, the lifestyle choices they are making, and
the impact those are having on their health,”
Through offering a prescription for healthy produce, FVRx
provides a tool that can aid rural physicians' efforts.
“With the FVRx program, providers can make
explicit connections between educating patients about the
importance of consuming fruits and vegetables and
empowering them with resources to facilitate those
healthier food choices,” said Morgan.
Optimizing Local Partnerships
One key principle of all three programs is teamwork. The
more people that are working together, the easier it is
to achieve goals than if working alone. Partnerships have
played a large role in increasing awareness of their
services and the overall impact on their patients'
For Knysh, partnerships have been built through
purchasing foodstuffs from local farmers and
organizations like Berkshire Grown,
instead of strictly buying from foodservice vendors.
“We developed a shared vision of building an
alternative food system that is deeply rooted in the
concept of supporting local producers and
vendors,” stated Knysh.
Working with local partners can further pique interest
from the community. Smith has seen that Knysh's efforts
to not only enhance Fairview's menus, but also shop
locally, have made a big difference in Great Barrington's
relationship with the hospital. The cafeteria is proof,
as non-patients flood in at noon for a healthy and tasty
meal. “Roger has opened the door to people by
raising awareness of all of our healthy resources around
the area, attests Smith. “Now, the community
doesn't stay outside. The community is coming
In most cases, food retailers are interested in having an
opportunity to be a part of a program that is increasing
their community's access to affordable, healthy food.
Similarly, local partnerships are vital for FVRx.
Patients can only redeem their prescriptions at locations
that have agreed to accept them. “Nationally,
there is a lot of excitement for fruit and vegetable
prescription programs,” said Morgan.
“In most cases, food retailers are interested
in having an opportunity to be a part of a program that
is increasing their community's access to affordable,
From a doctor's perspective, Lambke says that localized
partnerships are key to finding solutions for food
insecurity, obesity, and other health-related issues in
rural areas. “There are many misconceptions and
biases around these issues,” stated Lambke.
“It is helpful to build a structure around the
FVRx program that includes meeting with farmers,
nutritionists, physicians, and community health educators
to enable ways of improving processes and have open
communication when problems develop.”
HHL is seeing a change in dietary patterns of Lenoir
County residents. They are currently working to expand
their reach outside of North Carolina. Read more about
HHL in RHIhub's Rural Health Models &
His efforts have paid off. The Skowhegan Farmers' Market
has become one of the most successful in Maine. By
partnering with it, RFGH and Lambke have been able to
improve the health of many of their town's residents.
In Lenoir County, Ammerman advocates for health on an
individual and organizational level. Her partnership
efforts with HHL encourage local businesses like
hospitals, restaurants, and grocery stores to offer
healthier food and beverage choices that positively
affect their customers' health (for instance, adding less
sugar to their sweet tea). While Fairview Hospital, FVRx,
and HHL have taken different approaches, Ammerman
reflects the heart of all three programs with her
motivation to increase patients' access to nutrition's
food, ultimately, “making the healthy choice
the easy choice.”