Prescriptions for nutrition: How culinary medicine is advancing health equity in Michigan

This article is part of State of Health, a series examining health disparities, how they affect Michigan's children and seniors, and the innovative solutions being developed to address them. It is made possible with funding from the Michigan Health Endowment Fund.


Geamill Gibson left her son's doctor's appointment with a prescription, even though her son wasn't sick and didn't even need medicine. She took the slip of paper downstairs from her pediatrician's office and had the prescription filled right there on site — with oranges, apples, cherries, and other produce from the Flint Farmers Market.


Gibson takes her son to the Hurley Children's Clinic, which is in a unique location — right inside the Flint Farmers Market, on the second floor. As patients at the clinic, she and her son are able to leave every visit with a prescription for $15 worth of fresh food, thanks to the MSU-Hurley Children's Hospital Pediatric Public Health Initiative (PPHI).


"The program helps a lot because it helps me get healthy fruits and vegetable for my kids, and try to keep them eating fruits and vegetables," Gibson says.


Like a lot of Flint residents, Gibson says it's not always easy to find fresh food. The city has lost several of its grocery stores in recent years, leaving residents with few options when it comes to buying food. That's where the relatively new discipline of culinary medicine comes in. Culinary medicine initiatives help to advance health equity by increasing access to healthy food and building awareness of the importance of nutrition.


The idea is this: If people can get prescriptions for the medicine they need once they're sick, why not give them prescriptions for the very thing that can prevent sickness and other health issues in the first place?


"This is a public health nutritionist's dream, really," says PPHI nutrition director Amy Saxe-Custack. She refers to the opportunity to offer food prescriptions within the market, but also the market's location — directly across from Flint's main bus station.

Saxe-Custack was brought on board at Hurley by Dr. Mona Hanna-Attisha, who in addition to her work as a pediatrician has been widely recognized for her research that exposed elevated blood levels in Flint children during the Flint water crisis. The food prescription program, funded by grants from the Rite Aid Foundation and the Michigan Health Endowment Fund, started in early 2016.


Why food?


Saxe-Custack says that when she was brought on board at Hurley, she met with a number of dietitians and other health professionals who had been on the ground during and before the Flint water crisis. She consistently heard them comment that they were giving residents the education they needed on nutrition, but they weren't seeing action.


Saxe-Custack, who grew up in Flint, says one dietitian's words really hit home.


"She said, 'It's really hard for me because I stand in front of people and tell them how they're supposed to eat, but I know they can't access those foods.'" she says. "So we're putting the cart before the horse. We're not dealing with access. So, to me, this program is really helping us to help folks access fresh fruits and vegetables."


In 2017, Saxe-Custack conducted a study to see how people were using the prescriptions. She found that many of the people surveyed would hang onto their prescriptions until they "got to a point where they didn't have enough food in the house." Then they'd come to the market and shop for fruits and veggies.


"So access was a big issue, and I feel like this program really addresses that," she said.


The program in Flint might be a dream for Saxe-Custack, but it's not the only one of its kind. Michelle Gagliardi, program director for the Michigan Farmers Market Association, says farmers markets may be partnering with doctor's offices for as many as a dozen such programs throughout the state right now. Since such programs are grant-funded, Gagliardi says they tend to come and go, so it's tough to keep up-to-date numbers.


"The programs vary in patient base, scope, funding source, (and) how much they have available, which determines how many people they can reach," Gagliardi said.


One program, for example, might focus on diabetes, whereas another might be focused on obesity. The Flint Farmers Market, unrelated to the prescription program, recently hosted a local optometrist who spoke about the connection between diet and healthy vision. As part of her job, Gagliardi organizes events for the various programs to come together, share ideas, and identify best practices.


But it's not only farmers markets that are getting on board with the idea of culinary medicine. Kristi Artz is the medical director of lifestyle medicine at Spectrum Health in Grand Rapids and the lead physician for Spectrum's culinary medicine program. But rather than writing prescriptions, Artz and her colleagues, through different branches of their program, are teaching medical students and practicing doctors how to better educate their patients on nutrition.


"Most of the diseases that we see and treat in the hospital are diet-related diseases or lifestyle-related diseases," Artz says. "Poor nutrition and lack of movement and overwhelming stress, those are the things where we're realizing as practicing physicians we need to have more formalized education because they impact our patient population so dramatically."


Artz says she and her colleagues survey all their participants and consistently receive positive feedback. That could be, at least in part, due to the classes taking place in teaching kitchens, where participants get to dive right in and cook.


"It's super fun," she says. "That's the other thing. There's a lot of laughter and learning and getting your hands dirty in the kitchen, and it really breaks down barriers that people might have in another context like a doctor's office."


Beyond health, there's also an economic impact. Clinton Peck, owner of Bushels and Peck's Produce at the Flint Farmers Market, says the food prescriptions have allowed for a steady boost in business. Peck also prepares bags of produce worth $15 to leave behind at Hurley for the days the market isn't open. If patients come in on the market's off days and can't shop, they can still leave with $15 worth of food.

"(At) the market, you never know what you're going to come out with at the end of the day … so this makes that average a little higher," he says.


Karianne Martus, manager at the Flint Farmers' Market, says the program through Hurley is good for everyone involved.


"(Hurley) was so committed to the educational part off it, and we have the actual tangible stuff here, so it really just puts it all together," she says. "It's been fantastic."

Scott Atkinson is a Flint-based journalist who has written for the New York Times, The Guardian, and several other publications. He is the editor of Happy Anyway: A Flint Anthology, and teaches writing at the University of Michigan-Flint.

Geamill Gibson photos by Scott Atkinson. Amy Saxe-Custack photos by Mike Naddeo.
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