Dawna Burnett hung reusable shopping bags from the handles of her walker, filling them with plate-sized collard green leaves, deep red beets, a bushel of carrots with their leafy green tops, bags of sugar snap peas and thick rolled oats.
She plotted the week’s meals (a pot of vegetable soup and burrito wraps made with the sturdy leaves of romaine lettuce) as she navigated her walker across the sidewalk and into the grass of Kaiser Permanente’s Rockwood Medical Center. Over a loudspeaker, Puerto Rican salsero Hector Lavoe sings his classic El Cantante.
At a table nearby, Zenger Farm intern Taissa Achcar-Winkels serves samples of turnip-green frittata with fresh garlic and red scallions to patients from Kaiser Permanente’s Rockwood clinic, Multnomah County’s nearby Rockwood Medical Center and the Wallace Medical Concern coming to collect their weekly prescription of organic produce.
She settled into a chair along with other clients, farm staff and volunteers who had come out to celebrate an expansion of the Community-Supported Agriculture (CSA) Partnerships for Health.
Clinic patients cover a “co-pay” of $5 a week in exchange for about $27 worth of fruits, organic vegetables, whole grains and legumes through the program, which runs for 22 weeks beginning this month. The partnership is supported by Kaiser Permanente, Providence, OHSU Knight Cancer Institute and the USDA National Institute of Food and Agriculture. Uber is sponsoring rides for people with difficulty traveling to pick-up sites. And Bob’s Red Mill, a longtime supporter, donated 12,467 pounds of grains and beans this season.
“We know that the health of our members is determined more by things like housing and access to healthy food than the actual care they receive in the medical setting,” said Molly Haynes, director of Community Health at Kaiser Permanente. “Food is one very tangible thing we know many of our members aren’t able to gain access to.”
CSA Partnerships for Health began as a pilot in 2015 at Mid County Health Center, pairing 25 patients with the nonprofit Zenger Farm. Four years later, the partnership has expanded to service 251 patients’ families across five county clinics: Mid County, Southeast Health Center, North Portland Health Center, La Clinica de Buena Salud, and the newest, Rockwood Health Center. Kaiser Permanente, Wallace Medical Concern, OHSU Family Medicine at Richmond and Outside In also provide shares to their members.
Together they serve the state’s lowest-income communities, including the 97233 zip code in Rockwood, where people gathered Thursday evening to celebrate. Nearly 40 percent of residents in the area qualify for SNAP benefits, while three out of four students qualify for free or reduced lunch. And residents there face higher rates of chronic health conditions, such as obesity, type 2 diabetes and cardiovascular disease than any other place in the state.
“With the closing of the Rockwood Fred Meyer and more recently the Safeway Store on 181st, people have fewer options to access fresh, healthy foods,” said Commissioner Lori Stegmann, who grew up in the neighborhood. “Coupled with the high cost and lack of transportation, this means that too often people are relying on corner stores, fast food chains, and gas stations for their day-to-day food needs.”
A model that works
The traditional model of community supported agriculture requires members pay a full season’s share in spring; this supports the farmer’s upfront costs of seeds, planting and harvest. Members then travel to a weekly pick-up site, where they load up on whatever common and curious vegetables might be in season. That model doesn’t work for most low-income residents. Many can’t afford the average cost of a seasonal CSA, at $482. Even with subsidized shares, low-income residents often struggle to make the weekly pick-ups; juggling more than one job, relying on public transportation or living with complex and chronic health conditions.
Multnomah County and its partners have mitigated those barriers by providing scholarships to some people who can’t afford the subsidized price of the share. The pick-up sites are located at the same clinics where clients see their providers, and staff send text message reminders to CSA members. They coordinate clinic staff, volunteers and clients to make special deliveries when needed and schedule medical transports for clients who can’t drive or take the bus.Even the ride-sharing company Uber has joined the partnership, and will soon offer free rides to people who have medical or other barriers to transportation.
Those efforts have helped CSA Partnership for Health make striking changes in clients’ lives: 88 percent of members report improvements to their health and 86 percent report they’ve learned new ways to prepare vegetables, according to an evaluation by Betty Izumi, a professor in the OHSU-Portland State University School of Public Health.
“What has surprised me the most about our program is the sense of community and belonging that many of our members feel when they pick up their shares,” Izumi said. “For many of our members, our program is more than just another place to pick up vegetables. The interaction with other members, CSA staff and interns, and the farmer makes our model unique compared to other programs that aim to increase vegetable consumption.”
That was true for Kaiser patient Ariana Torres, a CSA member who came out Thursday evening to help Full Cellar Farm bag produce. And it’s true for Mid County Health Center clients Paula Hernandez and her 15-year-old daughter Yesica Sandoval-Hernandez, who now volunteer in cooking classes with Zenger Farm.
“I have five kids and only my husband works,” Hernandez said. “It helps our health, it helps our eating habits to have access to healthy foods.”
Her son, now 17, was once treated for fatty liver disease, made worse by the family’s diet high in processed foods, Hernandez said. His doctors at OHSU and Mid County Health Center recommended the family change how they eat. That’s when they enrolled in the CSA through Mid County. She learned to marry Oaxacan recipes with farm-fresh produce, creating pumpkin-flower quesadillas, cucumber water, and fresh caldo de res with bok choy and other spring vegetables.
Four years later, she said, her son is healthy and she’s teaching other families to prepare healthy, vegetable-packed meals.
Rockwood Health Center joined four other county clinics this year, offering 20 patients shares of the CSA in partnership with Full Cellar Farm.
“Being in Rockwood, it’s an interesting place. There are little resources, lots of poverty. Low access to healthy foods,” said Community Health Worker Sulma Flores who helps coordinate the program. She said she hopes the program expands the relationship between clinic staff and patients.
“I hope they trust us to be partners in their health,” she said. “I hope we can build relationships and this takes away the barrier of us and them, and builds community.”
To build community, Flores coordinates with the local library to promote summer reading. And she’s working to bring a zumba teacher out for free classes. She’s planning cooking classes for CSA members and grocery store tours with health experts who can teach clients ways to shop for healthy foods on the cheap. And that’s something providers at the clinic say they simply can’t do in a clinical setting.
“We can give someone all the medications in the world,” said Mary Jepson, a nurse practitioner. “But if their diet isn’t where it should be, there’s no way to get their disease under control.”
Community Health Nurse Edie Johnson treats patients with chronic diseases such as diabetes or high cholesterol. For them, the most effective treatment is a healthy diet. She has seen patients control their blood pressure, blood sugar, and weight by changing their diet.
“But a lot of families are dealing with so many other barriers. Some families have kids with developmental disabilities, or they don’t speak English, or they have different literacy levels. To provide one buffer is really meaningful,” she said. “It’s really discouraging when I work with a patient with diabetes and I know their diabetes would be so improved with diet, but I know what they have at home is a 20 pound bag of potatoes or a freezer full of microwave dinners.”
That’s why a program like CSA Partnerships for Health is so powerful, she said. “I got really excited,” she said, “because I felt like I had the opportunity to give people with these chronic illnesses a chance at accessing food as medicine.”
For client Dawna Burnett, a former smoker who is pre-diabetic and has had heart and lung problems, that means giving up childhood favorites such as fried chicken, fried okra and baked macaroni and cheese.
“I can still do some soul stuff, but the oil is gone now,” she said. “I eat good natural foods, and none of that processed stuff. I’ve done really well. I drink a lot more water. Don’t fry anymore. I’ll eat snap beans, snow peas, black beans, brown rice. Fruits. Any fruit is good; from the apple on down to the little blueberry.”