Program: Farmers markets, mobile markets, and CSAs
- Farmers markets, mobile markets, and community supported agriculture 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, Mobile Markets, and CSA programs often include diet and nutrition education to pair access to healthy foods with support for long-term behavior change.
- 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.
- CSA programs provide members with a box or a “share” of goods including fresh, local produce and other farm products.
- A mobile market serves as a consolidated farmers market that can be transported in a vehicle to food deserts, low-income communities, and areas with limited fresh, healthy food options.
- 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.
- Hospitals throughout the United States are hosting and supporting these programs and initiatives in order to create healthier community food environments and promote healthier eating behaviors for patients, staff, and the community at large. This brief highlights opportunities to utilize community benefit programs to facilitate these efforts.
- Hosting farmers markets on hospital grounds
- Screening patients and community members at risk of chronic health conditions and food insecurity for referral
- Addressing food insecurity and affordability by providing financial support to subsidize or otherwise support CSAs, farmers markets, and mobile markets
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.
- Joseph Alaro, Valle Encantado Farms and La Cosecha CSA
Growing and handling fresh produce safely
The federal government sets standards, conducts inspections, and maintains an enforcement procedure to maintain food safety for retail food outlets that distribute fresh produce, but does not provide the same regulatory guidance for small food producers that sell shares for CSA programs or food at farmers markets. However, there are many local and state guidelines and resources available for small-scale producers to safely sell their produce. For example, California’s Department of Food and Agriculture has a certified farmers market program including mandatory inspections and requirements for compliance. The following resources provide guidance for safe agricultural practices in the field, handling fruits and vegetables after harvest, and a sample food safety manual that food producers can create for dissemination to clients and potential partners.
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.
Challenges of small-scale farming
Smaller and sustainable food producers face steep competition from industrial farming operations that negatively impact human and environmental health. Smaller-scale farmers that produce for local markets tend to have lower incomes than large-scale producers, and they can be burdened with insurmountable debt. According to the National Agricultural Workers Survey, 30 percent of all farm workers had a total family income below the poverty line.
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
Eaton Rapids Medical Center, Mich. (Host a farmers market on hospital campus)
Eaton Rapids Medical Center
Eaton Rapids, Mich.
ERMC hosts a small community farmers market featuring ~5-8 vendors on their campus weekly from May to October and accepts SNAP, Double Up Food Bucks (DUFB), WIC, and Project FRESH benefits.
In 2017 the market achieved $6,181 in total sales, $208 spent on SNAP benefits, and $158 spent in DUFB.
Florida Hospital (Provide financial support for mobile market vehicle)
Fresh Stop Mobile Market
The community impact department of Florida Hospital awarded a grant for the Fresh Stop Mobile Market, which included refrigerator shelves for the market van, enabling delivery of fresh produce to community centers in food deserts.
The Fresh Stop bus delivers fresh, healthy food to 16 locations in food desert neighborhoods.
Penn State Health Milton S. Hershey Medical Center (Fund or lead food and nutrition classes)
Penn State Health Milton S. Hershey Medical Center
Food as Medicine at Farmers Market in Hershey
The Food as Medicine Program offers several educational opportunities including Prevention Produce, which matches patients or community members with a student “nutrition navigator.”
Participant Loretta McCall was able to bring her blood pressure down by “Substituting soy, cutting fat, reading nutrition labels and using food preparation methods that don’t involve frying.”
Highland General Hospital, Calif. (Fund or lead food and nutrition classes)
Highland General Hospital
In 2011, HGH also launched the “Bite to Balance” program to provide families with children diagnosed with obesity or a chronic disease with CSA boxes and nutrition education. HGH provides funding for the program in collaboration with a local organization. Staff members paid in full for their box ($24 per share), and a portion of this money was used to subsidize the cost of free- or reduced-price boxes for low-income patients.
According to a presentation released in 2015, 68% of participants of the “Bite to Balance” program reduced their body mass index.
American Indian Health, Mich. (Host a community supported agriculture distribution site)
American Indian Health and Family Services
Fresh Prescription & Fresh Food Share
American Indian Health and Family Services implements a fruit and vegetable prescription program by distributing Fresh Food CSA shares to members. They partner with gleaners to support the initiative in the winter months.
88% of participants of the Fresh Prescription program, including several other hospitals and health systems in Michigan, reported eating more fresh fruits and vegetables in 2015.
In 2015, 88% of participants also increased their knowledge about the importance of fruits and vegetables in their diets and/or where to purchase fresh produce in their community.
Lourdes Hospital, N.Y. (Host a community supported agriculture distribution site)
Binghamton Farm Share
Lourdes Hospital donates to and distributes boxes for VINES Binghamton Farm Share, which includes a 50% discount share for qualifying members receiving SNAP, WIC, or within a specified income bracket.
VINES Farm Share provided fresh food boxes to 110 participating members in 2015.
50% of participants received a discount on their share in 2015.
Presbyterian Health Services, N.M. (Offer financial support for subsidized CSA program or purchase CSA shares)
La Cosecha CSA
Presbyterian offers financial support to subsidize CSA shares to ensure both affordability of the shares and the livelihoods of local producers.
Indiana University Health (Conduct health screenings or food insecurity screenings)
Indiana University Health
Fishers, Zionsville, and Brownsburg Farmers Markets
IU Health Staff were present on the first Saturday of each month at local farmers during the 2016 and 2017 summer months to implement the Fresh & Fit challenge and conduct health screenings.
IU Health Staff collected pre- and post-program data on participant blood pressure, cholesterol, and A1c levels.
Lakewood Health System, Minn. (Conduct health screenings or food insecurity screenings)
Lakewood Health System
Choose Health CSA
Physicians screen patients for food insecurity and “prescribe” eligible patients for a free Choose Health CSA membership. The free CSA program is funded collaboratively by a variety of community organizations, foundations, and through the Minnesota Department of Health. Staff also conduct pre- and post-program health screenings to facilitate evaluation.
In the first year of programming, 51 families attending well-child or obstetrician visits responded yes to one or both of the Hunger Vital Sign screening questions, expressed interest, and enrolled in the Choose Health CSA program.
In the second year, 75 families enrolled in the program.
Waldo General Hospital, Maine (Assist with data collection, data analysis, and evaluation)
Waldo General Hospital
WGH conducted a consumer survey to assess community interest in and use of CSAs, including prohibiting factors, and knowledge/use of Waldo Fresh CSA.
52% of respondents indicated that they knew where and when to purchase a CSA in their local community.
68% of respondents reported that cost was important or very important to them when purchasing food.
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.