Guelph Community Health Centre, located in Guelph, Ontario has been reducing  health inequities by providing interprofessional primary health services and community programs, focused on the populations we prioritize, in collaboration with community partners. One of the ways Guelph CHC has achieved this is by implementing The Seed Fresh Food Prescription (FFRx) program which has been running since 2019 and has now wrapped up its second phase!

Food prescription models have been growing in popularity in the United Kingdom and the United States and now in Canada. In 2018, the Ontario Alliance for Healthier Communities (AHC) launched a pilot project to support social prescribing programs. In the Wellington-Dufferin-Guelph region, Guelph CHC participated in this project and introduced several initiatives to better link patients with community services.

The SEED, a food access program run out of Guelph CHC, dedicated to addressing food insecurity, leveraged this opportunity to secure funding through AHC, the Trillium Foundation, The McConnell Foundation, and The Sprott Foundation, to establish a fresh food prescription program called The Fresh Food Prescription Program or better known as FFRx. It was important to The SEED to implement food prescribing as 12% of Guelph’s population is food insecure and primary care and community health staff saw first-hand that food insecurity was associated with poorer physical, mental, and social health and felt motivated to address food insecurity within their care.

Food prescription programs are intended to improve participants’ food environments by altering one or more of the dimensions of healthy food access:

• acceptability- alignment with preferences, dietary restrictions, and cultural food practices; and
• affordability- relative cost of healthy foods;
• accessibility- location and ease of access to healthy foods;
• availability- perceived adequacy of supply of healthy foods;
• accommodation- meeting the needs of those accessing food.

What is Fresh Food Rx?

Fresh Food Rx (FFRx) is a program and series of research studies, implemented by The SEED team at the Guelph Community Health Centre.

The SEED is a team of 20+ people at the Guelph CHC that is working toward local food security in many ways. Some of The SEED’s activities include warehousing and distributing food to partner organizations and individuals in dignified and accessible ways, rescuing and ‘upcycling’ food that would otherwise go to waste, sharing and engaging around food via community kitchen and garden programs, and advocating for more awareness and policy changes to address the root causes of food insecurity.

Being embedded at a health centre, with health care providers such as doctors, social workers, registered dietitians, etc, puts The SEED in a unique position to dig into and emphasize the relationship between food and health.

The doctors, social workers, etc. can actually prescribe food to community members who are experiencing both a) food insecurity and b) a chronic health condition that could be related to their nutrition. The SEED team, part of the same organization, can then source and deliver the food.

FFRx Phase 1 started in September 2019 with a successful 12-week pilot, which supported 60 households. Phase 2 began in the spring of 2021, which supported another 60 households and close to 200 individual people for a full year. This phase has now ended, and we are currently looking at opportunities for Phase 3, with the help of our research partners at the University of Victoria and University of Waterloo.

How does a food prescription work?

For Phase 2, participants received weekly money in the form of vouchers, which were used at Groceries from The SEED to purchase their choice of fruits and vegetables. Groceries were then delivered to them, free of charge.

The second phase of FFRx has just finished. People who received the support from this program were clients of Guelph CHC whose priority populations are people who have low incomes, newcomers to Canada, disabled people, and people experiencing other barriers to their health and well-being.

From May 2021 to October 2022, 61 households (178 people) were prescribed 10 dollars per person in their household per week for 52 weeks by a health care worker to buy fruits and vegetables from an online grocery store operated by The SEED. In conjunction with this support, individuals could voluntarily be involved in a research study investigating the outcome of food prescribing. The effectiveness of this program improved significantly after working with community members on addressing their barriers through practice changes such as reminder phone calls, using interpreters, and increasing avenues for ordering.

The SEED team made a huge effort to make this program as accessible as possible by providing solutions that fit people’s individual needs, like weekly reminder phone calls, access to interpretation, different options for ordering, and more! Phase 2 participants benefitted from:

• regular check-ins with the FFRx team;
• access to Groceries from The SEED (discounts on other products in addition to prescribed free fruits and veggies);
• encouragement to see a registered dietitian for added support.
• •  

While receiving food access support, community members were asked if they would like to be involved in the research study, which evaluated the prescription’s benefits. We measured impacts on self-reported health, food access, and amount of fruit and vegetable consumption. We also measured biometric impacts like blood pressure, cardio metabolic blood markers, and micronutrient status.

This program has had a tremendous impact on the community, people have shared their stories of improved well-being, less stress on their budgets and increased connection. In the end of study qualitative data collection, one participant shared that she often feels invisible as a person of color, that walking into stores she feels like she is not acknowledged or respected. When she spoke about walking into the SEED warehouse to use her FFRx voucher she said “Everybody was lovely… I was acknowledged…They were very good…I left feeling very good.”

Impact on Food Insecurity  

Our Phase 2 findings are in, and they look promising! We saw a 43% reduction in severe food insecurity after 52 weeks in the program. People moved from severely food insecure to moderately food insecure, which explains the increase in that category:

It is important to note that these benefits will only continue while FFRx exists. Since Phase 2 has ended, community members are already reporting that it is very difficult to afford enough food to meet their basic needs, let alone the full amount of fruit and vegetables they want.

This program has led to a 43% reduction in severe food insecurity for those who were in the program for 52 weeks. Program organizers are beginning to use the project outcomes to help advocate for health care to continue to address social determinants of health and to advocate for higher social service rates for people so that they can practice their right to safe and acceptable food. With further support from The SPROTT foundation the FFRx program will begin to provide prescriptions once again to people in the coming months.

The deep impact of fresh food prescriptions

One participant said that she was able to save some of her Ontario Disability Support Program (ODSP) money that she would normally use for food, and use it to take her teenage son to a trampoline park. She teared up talking to our researchers about how she was able to do something special for her kid that she is never able to do normally.

Another participant explained that she often feels invisible as a person of color, that walking into stores she feels like she is not acknowledged or respected. When she spoke about walking into the SEED warehouse to use her FFRx voucher she said “Everybody was lovely… I was acknowledged…They were very good…I left feeling very good.”

What’s next for FFRx 

The SEED Team is committed to continuing Fresh Food Rx. There is a significant need for more comprehensive studies to determine the potential of this model. We want to know more about food prescriptions’ ability to alleviate food insecurity and improve health, while reducing long-term burdens on healthcare systems and reliance on medical interventions.

We have been given more funds from MAZON Canada and The Sprott Foundation, to continue our work with food prescribing. We hope to provide more food prescriptions to those who were involved in Phase 2, starting in the new year.  Additionally, Our Food Future has awarded us funding to help us expand the food prescribing model within both Guelph and Wellington County!  Guelph and Wellington’s Ontario Health Team network will be instrumental in helping us expand to other health care partners in the area.

We will be using our results from Phase 2, especially qualitative data about how our community members experienced the program, to improve upon our model.

We know that food insecurity is an income-based problem. Our teams at Guelph CHC and The SEED will continue to advocate for income-based solutions and policy change.