Every other Friday, the hosts two live cooking classes 鈥� one in English and one in Spanish. Last week, Brenda Munoz made a classic tuna melt with an orange, romaine and dandelion salad.
鈥淒andelion is completely edible,鈥� said Munoz, holding the small leaves from the flower. 鈥淭hey鈥檙e really high in vitamin A and folate.鈥�
But this isn鈥檛 your typical cooking lesson on Zoom and Facebook. It鈥檚 part of a 鈥渇ood prescription鈥� experiment 鈥� prescriptions for healthy food instead of pills. Diabetics get a free box full of fruits, vegetables, chicken breast, quinoa and other nutritious food delivered to their homes every two weeks 鈥� and then can learn some recipes.
Advocates who want to expand the program across California say it could very well be a way to improve chronic conditions, lower health care costs and reduce hunger, all at the same time.
It鈥檚 aimed at people like Shane Bailey, a 72-year-old who served in the Coast Guard who has three heart conditions, diabetes, kidney disease, high blood pressure and cholesterol. A participant in the Stockton food bank鈥檚 , she says her lifestyle has dramatically improved since she began receiving produce prescriptions last year.
鈥淢y primary doctor is impressed with my cholesterol because they say it鈥檚 better than theirs!鈥� said Bailey, who has started meal prepping using cookbooks from second-hand stores, reading food labels closely, and experimenting with different kinds of squash and greens.
鈥淢y dream is to live to 95,鈥� she said. 鈥淚f we start younger, then maybe people won鈥檛 get sick until they鈥檙e in their 80s and 90s.鈥�
Food prescriptions are part of the 鈥溾�� movement that views nutritious food as a way to prevent, manage, and reverse chronic disease. Such programs have been found to lower , , and . that incentivizing healthy eating could save $100 billion in national healthcare costs over the projected lifetimes of current Medicare and Medicaid patients.
Across California, a patchwork of food prescription programs are being tested using a variety of strategies, while an ambitious initiative to reform Medi-Cal and a bill that failed in the Legislature this session would standardize the effort.
A California experiment
At the beginning of 2022, California launched a , called CalAIM, to address the root causes of diseases based on 鈥�,鈥� which considers biological, behavioral, social, and environmental factors.
CalAIM encourages Medi-Cal managed health plans to experiment, allowing them to opt in to provide , such as housing navigation, assisted living and sobering centers.
The goal: Improve the health of Medi-Cal patients with lower-cost treatments. By the end of 2022, all 58 California counties offered services, while 16 counties offered at least 10 and three counties 鈥� Sacramento, Riverside, and San Diego 鈥� offered all 14.
Medically supportive food programs, which include medically-tailored meals and food prescriptions, are the third most popular service. In 2022, used food programs, the vast majority the more established medically-tailored meals program.
Katie Ettman, a food in healthcare expert at the San Francisco , said there is vast potential for food programs, considering that California has the largest Medicaid program in the country with about .
But the challenge is getting counties and health plans to start them.
鈥淭he vast majority of them don鈥檛 even know how produce prescriptions work,鈥� said Brent Ling, director of external affairs at the nonprofit . 鈥淪o it鈥檚 a lot of education and information sharing.鈥�
There are also a variety of food prescription programs being funded outside CalAIM. The Stockton program is being financed by the philanthropic , Kaiser Permanente is funding a test in Los Angeles County, and programs in San Diego County and San Francisco are being funded by their local governments.
The federal Farm Bill is in California. One is in Alameda County. What started as in 2019 has evolved into California鈥檚 most successful medically supportive food program that is integrated into the county鈥檚 healthcare system.
The program has 11 sites across Alameda County and serves almost 4,000 people according to Steven Chen, its chief medical officer.
Chen believes the testing across California is an important stage to make the services a permanent benefit under Medi-Cal: 鈥淎ny innovation starts with fragmentation, because it鈥檚 a 1,000 flowers bloom approach鈥� You want to create enough openness because otherwise, it鈥檚 just a top down approach, which never works.鈥�
Alameda County screens for food insecurity and offers people who might not have chronic conditions prescriptions and health coaching to prevent developing in the future.
鈥淭here鈥檚 so many benefits,鈥� Chen said. 鈥淲e鈥檙e getting human health, economic health, climate, health, and equity all together by really asking the question, 鈥淲here does the food come from?鈥濃��
A covered benefit?
This session, was introduced that would have required Medi-Cal to cover medically supportive food and nutrition for at least 12 weeks for eligible Californians.
鈥淚 remember opening the fridge and seeing only celery and peanut butter and my mother telling me we were on a 鈥榮pecial diet鈥�. I did not realize at the time we were food insecure,鈥� said Assemblymember , an Oakland Democrat who proposed this bill. 鈥淭oo many Californians, particularly Californians of color, are living with largely preventable chronic conditions.鈥�
While Bonta highlighted how this bill would help the state save money in the long run, its estimated cost was in the tens of millions of dollars. With the $30 billion-plus state budget deficit, the bill was held in the Assembly appropriations committee.
Bonta鈥檚 office and bill said that they plan to reintroduce the bill next year.
National momentum for food prescriptions is growing. Last year, the White House on hunger, nutrition and health that prioritizes 鈥渇ood is medicine鈥� interventions including food prescriptions.
Combined with grassroots efforts across California, the bill will gain momentum, Ettman said.
One successful local program is in Solano County, where Rich Oliver drives a colorful box truck painted with crates of fruits and veggies to clinic parking lots during the week.
鈥淲e are purposely outside of clinics because we want patients in the clinic to have access to this,鈥� says Oliver, who is the coordinator of the county鈥檚 鈥渕obile food pharmacy.鈥�
The program began in 2018 when the county partnered with the local food bank and the Yocha Dehe Wintun Nation, a federally recognized native tribe. From April to June this year, the truck served 16,000 people, according to the .
At county clinics, providers give patients facing food insecurity or diet-related health conditions a paper food prescription. If the food truck is there that day, patients can then stop by the nearby truck or parking lot.
On Tuesday mornings, the truck parks outside a Fairfield health clinic. Last week, Jose Leyva, a 67-year-old Suisun City resident on disability, handed over his wife鈥檚 prescription and received potatoes, onions, cantaloupes, lettuce and a 25-pound box of pantry staples.
鈥淲e don鈥檛 have much money for the grocery store because it鈥檚 too tight,鈥� says Leyva, who regularly picks up food from the truck for his diabetic wife. 鈥淭his helps a lot.鈥�
is a nonprofit, nonpartisan media venture explaining California policies and politics.