Farmers markets, mobile markets, and community supported agriculture (CSA) programs promote access to healthy foods and can strengthen sustainable food systems by supporting local producers while improving the affordability of fresh, local produce for low-income communities. 

Farmers markets provide space for local vendors to sell fresh fruits, vegetables, and other farm products, serve as a place for community gathering, and offer an important opportunity for improved physical and economic access to healthy foods. Farmers markets typically take place in community spaces including town centers, streets, schools, and health care facility campuses. 

Hospitals throughout the United States host farmers markets in order to create healthier community food environments and promote healthier eating behaviors for patients, staff, and the community at large. Hospital-based farmers markets increase access to fresh, healthy foods and may also provide healthy recipes, cooking demonstrations, and other health-promotion materials.

Farmers markets are associated with health behavior change. A survey conducted at 37 Kaiser Permanente-hosted farmers markets and farm stands found that 74 percent of patrons reported eating more fruits and vegetables as a result of coming to the market. And a federally qualified health center’s farmers market initiative found an average increase in fruit and vegetable consumption of 1.6 servings per day among low-income diabetics.

Farmers markets have experienced substantial growth in both popularity and reach in the past decade. In order to increase the availability of fresh fruits and vegetables to low-income households and further encourage Supplemental Nutrition Assistance Program (SNAP) recipients to purchase and prepare healthy foods for their families using SNAP benefits, the U.S. Department of Agriculture (USDA) has encouraged and provided support for farmers markets to accept SNAP. Farmers markets in all 50 states now accept SNAP benefits; there has been a 129 percent increase in the number of SNAP authorized farmers markets and a 35 percent increase in SNAP redemptions at farmers markets nationally between 2012 and 2017. 

A mobile market serves as a consolidated farmers market that can be transported in a van or other large vehicle to food deserts, low-income communities, and areas with limited fresh, healthy food options. Many mobile markets are refrigerated trucks or have refrigerated shelves to support the transport of fresh produce and other perishable farm products. Establishing multiple and diverse community partnerships is vital in expanding the reach of mobile markets. 

Go Fresh Mobile Farmer’s Market serves 12 low-income neighborhoods in Springfield, Mass., with weekly stops at locations including subsidized housing complexes, senior centers, and community clinics. Participant surveys found that most shoppers had chronic health conditions that are affected by diet, and that fruit and vegetable consumption increased by an average of one serving per day after respondents started using the mobile market.

Community supported agriculture programs provide members with a box or a “share” of goods including fresh, local fruits, vegetables, eggs, bread, and other farm products that are in harvest at the time of distribution. Traditionally, CSAs are programs in which consumers commit to supporting a local producer or group of producers for a growing season, paying up front for a share or membership that provides the producers with needed financial support at the beginning of the growing season. In return, the members receive a box of fresh local produce weekly throughout the season.

Members pick up their produce boxes weekly at predetermined times and locations. Convenient locations include local businesses, universities, recreation centers, Women Infants, and Children (WIC ) Food and Nutrition Services offices, community organizations, and hospitals and other health care facilities.

Making local, healthy food accessible

Farmers markets and CSA programs not only can increase physical and economic access to fresh, healthy foods for vulnerable populations, but they also can support farmers and businesses and keep food dollars circulating in the local economy. 

Local, organic producer groups such as La Cosecha, in Albuquerque, N.M. are dedicated to sustainably producing fruits and vegetables and paying a fair wage to their farm workers. Yet it is sometimes difficult for them to compete with local supermarket prices in their low-income community. As a result, they have found creative ways to make their produce available to their own neighbors.
 
In order to address affordability, farmers markets and CSAs may employ a variety of strategies to reduce the cost of their produce or CSA shares for low-income households. 

• Partner with community organizations, including hospitals, to implement subsidized fruit and vegetable coupon programs such as Veggie Rx and Double-Up Food Bucks to increase low-income consumers’ produce purchasing power.
• Utilize the revenue from full-priced CSA shares to subsidize the cost of low-income shares. The full priced CSA boxes, sold at a slightly higher price, offset the lower cost of discounted shares. 
• Obtain grants or financial support to provide low-income households with subsidized CSA shares. This funding enables low-income families to afford CSA produce while helping to cover farmers’ large beginning of season costs that would not be covered sufficiently otherwise by the discounted shares. 
  • A local nonprofit organization in New York secured external grants, donations, and held fundraisers to provide low-income residents with half-price shares. There are eight different farms and CSA programs that participate in the program.
• Offer CSA members the option to pay for a part of their share by contributing some of their time and labor to the farm. 

Community supported agriculture sales, including a subsidized share-for-share CSA program and a SNAP CSA program, accounted for 73 percent of the total sales for World PEAS Food Hub in Eastern Massachusetts. Local farmers participating in World PEAS grew their combined income from $39,397 in 2008 to $157,322 in 2014.

Connecting with community partners and initiatives 

Hospitals interested in hosting or supporting farmers markets, mobile markets, or CSA programs should form relationships with established farmers markets, farmers markets managers, and local producer organizations when this is possible. This may allow facilities to add value to existing programs, especially those that serve vulnerable communities.

Local Harvest serves as a resource for community benefit staff to locate farms, food producers, farmers markets, and CSAs operating in their community. Acting as a support system for regional and sustainable food producers, Local Harvest offers memberships that include a personalized listing on their website, technical support for administrative duties, and connections to consumers and local organizations that share similar objectives. 

Recommendations for hospital participation

Local farmers markets, mobile markets, and CSAs offer important opportunities for health care-community partnerships to improve access to healthy foods in vulnerable communities. 

Hospital staff can identify patients at risk of chronic health conditions and food insecurity for referral to local farmers markets, mobile markets, and CSA programs. In order to address food insecurity and affordability, community benefit programs can provide financial support to subsidize CSA boxes for low-income families

Hospital campuses can be great locations for farmers markets, however, in order to achieve community benefit objectives to address healthy food access for vulnerable individuals and households, it is important that initiatives target and directly serve vulnerable communities. Hospitals that are not located in food deserts or low-income communities can provide funding to purchase and maintain a mobile market vehicle that delivers fresh produce to low-income or food desert neighborhoods. 

Farmers markets, mobile markets, and CSA programs often include diet and nutrition education to pair access to healthy foods with support for long-term behavior change. Cooking classes, tastings, recipes using seasonal produce, or nutritional mentorships are all effective strategies. Classes and demonstrations can be offered by hospital-sponsored dieticians, chefs, and gardeners. 

Additional information about hospital roles and examples are included in the table below.

Examples of hospital roles and participation

Learn more

Farmers Markets

This Health Care Without Harm fact sheet shows steps for hospitals to host a farmers market or a CSA program at their facility.

The Massachusetts Government Executive Office of Energy and Environmental Affairs offers guidance for organizing and operating a farmers market through all stages. 

The University of Kentucky Cooperative Extension Service provides guidance for establishing and organizing a community farmers market including a proposed timeline, actionable steps, and key topic areas. 

The USDA developed a digital National Farmers Market Directory to facilitate identifying and connecting with established farmers markets in your community. 

Local Harvest engineered an interactive map of farmers markets in the United States. 

The USDA has an additional directory of state farmers market SNAP contacts and has a collection of resources for farmers markets that are interested in becoming SNAP authorized. 

Community supported agriculture programs

Local Harvest developed an interactive map of CSA programs in the United States to facilitate identifying and connecting with established CSA programs in your community.