Poster Topical Area: Community and Public Health Nutrition

Location: Auditorium

Poster Board Number: 158

P06-138 - Fruits and Vegetables on Prescription: A literature review and ethical analysis of produce Rx programs as a novel preventative intervention

Monday, Jun 11
8:00 AM – 3:00 PM

Objective: To explore the ethical considerations and policy implications of produce prescription (Rx) programs.

Methods: A review of the literature identified study duration, Rx design, participant inclusion criteria, and the role played by a referring medical professional. Inclusion criteria were interactions between a medical professional and patient in a healthcare setting where prescription(s) for the consumption of fruits and vegetables was issued. An ethical matrix then evaluated the wellbeing, autonomy, and fairness from the perspective of adult patients; children patients; patient families; participating local farmers; physicians, of all types; and government assistance programs.

Results: Nineteen articles have been published on produce Rx programs. Low-income patients were targeted in 14 articles, while 13 studies identified populations with diet-related health conditions such as diabetes or hypertension. Only 9 studies targeted both health and low socioeconomic status. General practitioners and community health workers were the most common referring physician, while farmers at on-site clinics or local farmer's markets were primary food retail. An ethical analysis indicated that despite lower financial burdens and greater food choice, Rx programs may have unintended psychosocial consequences on low-income participants. Healthcare professionals benefit from firsthand experience employing a partnership model of care, building trust and emotional intelligence. Participating farmers benefit from an enlarged customer base, but may experience greater financial burdens. Some Rx programs could use existing government assistance systems (i.e., Medicaid in medically underserved areas or SNAP in food deserts), though disbursement may be cost-inefficient and disorganized without policy cohesion.

Conclusions: Future research must test a variety of Rx designs to ameliorate tradeoffs in wellbeing, fairness, and autonomy. As pilots grow in scale, programs must acknowledge the critical roles and perspectives of healthcare professionals and local participating farmers. Programs must also determine whether Rx incentives will use the existing systems of government assistance programs to target low-income populations, those with diet-related health conditions, or both.

Funding Source: Johns Hopkins Berman Institute of Bioethics, Global Food Ethics and Policy Program

Haley Swartz

Research Program Coordinator
Johns Hopkins University
Baltimore, Maryland