Produce and Public Health

Partnerships are using produce prescriptions, incentives, and innovation to improve health and drive consumption.

Fresh fruits and vegetables are directly tied to reversing the nation’s two leading causes of death, and Americans are not eating nearly enough of them. Heart disease and cancer account for more than 40% of all U.S. deaths, according to the National Vital Statistics Report published Sept. 16, 2025.

Yet, produce consumption remains stubbornly low. Only about 12% of adults meet the recommended daily fruit intake of 1.5 to 2 cups, and just 10% reach the 2 to 3 cups of vegetables recommended in the 2020-2025 Dietary Guidelines for Americans, according to CDC reports. The health impact of closing that gap is simple, side-effect-free, and scientifically backed.

“Improving fruit and vegetable consumption is one of the most evidence-based strategies for strengthening public health. This is why so many Food as Medicine programs start with increasing produce consumption,” says Mandy Katz, MS, RD, CSP, LDN, healthy living director, Giant Food, 166-store chain headquartered in Landover, MD.

“Over time, increased produce consumption can reduce healthcare costs, improve quality of life, and support community wellbeing, making retail an active partner in public health, not just a place to shop.”
— Mandy Katz, Giant Food, Landover, MD

From a retail perspective, Katz adds, “the produce section is more than just a department, it’s a public health intervention that greets individuals every time they walk into the grocery store. People visit grocery stores far more often than they see a clinician, giving retailers a unique opportunity to influence daily health behaviors. When we make produce more visible, more affordable, and easier to use, we shift consumer norms toward healthier eating.”

Consumers say cost is one of the biggest barriers to eating nutritious foods. More specifically, about seven in 10 Americans say the increased cost of food in recent years has made it more challenging to eat healthfully. A larger share of lower-income adults than upper-income adults express this view (77% vs. 54%), according to findings from a Pew Research Center survey, Americans on Healthy Food and Eating, conducted in early 2025, among 5,123 U.S. adults.

RETAILER FOCUS:

One way to lessen the cost barrier is to produce prescription plans, retail-led initiatives, and federal programs that offer cards or coupons for free fresh fruits and vegetables that participants purchase at retail. Many are based on medical need.

• Produce Prescription Plans. Over the last decade, many produce prescription plans have moved from pilot concepts to operational tools that route healthcare dollars directly into produce departments, with retailers serving as the delivery system.

Eat Well, managed by the non-profit Reinvestment Partners in Durham, NC, launched a pilot at Food Lion in 2016. The 1,100-plus store retailer, headquartered in Salisbury, NC, initially loaded fruit and vegetable funds onto its loyalty cards.

As the model expanded, flexibility became essential, leading to a retailer-neutral restricted debit card accepted at major national chains, including Ahold Delhaize banners, Kroger, Albertsons, Walmart and Instacart.

Participants, most often individuals managing diet-related chronic disease, are enrolled through health plans, care managers, dietitians and community health workers. Monthly produce benefits range from $40 to $320, depending on program intensity. Funds are limited to fruits and vegetables — fresh, frozen, or canned without added ingredients.

“It’s a very smooth process. There are no vouchers, no special trips, and no changes required at checkout,” says Neal Curran, director of food programs.

DC Greens’ Produce Rx followed a similar evolution, beginning in 2012 as a small farmers market program using paper vouchers before scaling into a regional model spanning grocery stores and markets across Washington, D.C., Maryland and Virginia. Physicians prescribe fruits and vegetables to Medicaid recipients. Debit cards average about $100 per month and typically run for one year.

“Access and education go hand in hand,” says Eric Angel, executive director, emphasizing that produce dollars are paired with nutrition education to support lasting change.

The Food Trust, Philadelphia, PA, approaches produce incentives through a combined access, affordability, and education framework, operating Food Bucks and Food Bucks Rx programs tied to SNAP transactions and healthcare-issued prescriptions.

“By integrating incentives into existing retail systems, the program encourages repeat visits, while allowing families to select fruits and vegetables that align with culture, taste and cooking habits,” says Julia Koprak, associate director.

Vouchers for Veggies/Eat SF traces its roots to physician-led innovation in San Francisco, CA, where founder Dr. Hilary Seligman recognized that prescribing medication without addressing food access left a critical care gap. The program now operates in multiple regions, typically providing $40 to $120 per month in fruit and vegetable benefits over six months.

“We really want to get people in the habit of eating fruits and vegetables,” says Cissie Bonini, executive director of the program, which is part of the Food Policy, Health, and Hunger Research Program at the University of California, San Francisco.

Across these four programs, health outcomes show consistent patterns. Participants increase their fruit and vegetable intake by about one serving per day, with reported reductions in A1C, blood pressure, BMI, and medication use.

• Retailer-Led Initiatives. Giant Food’s Healthy Flexible Rewards program, says Katz, is an example of the retailer’s success in encouraging and enabling shoppers to buy more produce. A loyalty rewards program that gives more points for healthier purchases can influence behavior change, which helps reduce the cost as a barrier to healthier eating, according to Katz.

“When healthy options earn more rewards, customers don’t need to work harder to make healthy choices; the system guides them there,” she says.

• Federal Programs. Public health programs that align with the 2020-2025 Dietary Guidelines for Americans, like WIC (USDA’s Special Supplemental Nutrition Program for Women, Infants, and Children), have been shown to increase fruit and vegetable consumption and improve health outcomes. Following the fruit and vegetable benefit increase in 2021 from $9 to $11 to $35 per month, WIC shoppers spent $12.40 more per month on WIC-eligible produce — $9.30 more than non-WIC shoppers.

Today, children receive $26 a month, and mothers receive $48-$56.

“In 2025, President Trump proposed cutting the fruit and vegetable benefit by 75%, but Congress smartly chose to fund it fully,” says Mollie Van Lieu, vice president of nutrition and health for the International Fresh Produce Association, Washington, D.C. “We will be advocating for its full funding in 2026. Fortunately, the MAHA (Make America Healthy Again) Commission has identified the WIC fruit and vegetable benefit as a proven intervention to support public health, so we will use that momentum going into 2026.”SNAP (Supplemental Nutrition Assistance Program, formerly called food stamps) participants are not required to purchase healthier foods, Van Lieu adds. “While the evidence is clear on poor health outcomes associated with sugar-sweetened beverages, practically speaking, we have no evidence that banning soda and junk food will drive fruit and vegetable purchases. We will support proven interventions, like SNAP incentives, that show increases in fruit and vegetable consumption.”

GROWER FOCUS:

Another way to overcome the cost barrier to consuming more fresh fruits and vegetables is to provide free boxes of produce. These are programs that can especially benefit growers.

• Food Box Programs. Food box programs that started as emergency relief during COVID-19 are now settling into a different role: reimbursable healthcare benefits built around fresh produce.

At SunTerra Produce in Newport Beach, CA, that shift is fully evident in how Project Food Box operates today. The program enrolls Medicaid members with diet-related chronic conditions and begins with a telehealth assessment conducted by dietitians.

Participants receive 20- to 22-pound boxes of fresh produce delivered weekly, supported by recipes and preparation guidance.

“The program captures as much as 30% of produce that falls outside retail cosmetic or sizing standards and moves it through coordinated partnerships with food banks, healthcare providers, and faith-based organizations, creating both an outlet for growers and a consistent source of fresh fruits and vegetables for communities with limited access,” says Steve Brazeel, founder and chief executive officer of both SunTerra and Elevated Foods, the latter of which operated Project Food Box.

In Puerto Rico, Caribbean Produce Exchange (CPE), a produce distributor based outside San Juan, is scaling FoodBox programs through Medicare Advantage.

Puerto Rico is a priority market because more than 55% of Medicare recipients are dual-eligible for Medicaid. CPE supports the program with large cold-storage warehouses that can convert full container loads into food boxes, at about 3,000 loads per year. The standard Medicare FoodBox is a quarterly benefit valued at $100 to $140, with roughly 70% of its contents as fresh produce.

“There are two magic words: local and fresh,” says Angel R. Santiago, president and chief executive officer.

Nationally, Planet Harvest, a for-profit company headquartered in Glencoe, IL, focused on reducing food waste, has organized its Food Farmacy as a framework linking a grower network with healthcare providers, employers, and community organizations.

Programs range from produce boxes to workplace wellness initiatives. Education is embedded through recipes, storage tips, and a new partnership with Thrive Global, a New York, NY-based behavior change technology company.

“When people have affordable access to fruits and vegetables, and they change their behavior to include them regularly, health outcomes can improve,” says Melissa Melshenker Ackerman, managing member and chief executive officer.

At the regional level, 4P Foods, a fresh produce distributor based in Warrenton, VA, partnered with Children’s National Hospital in Washington, D.C., on the FliPRx prescription program. Serving food-insecure families with children who are at risk for obesity or diabetes, the program delivers weekly produce bags sourced from more than 100 Mid-Atlantic growers.

“It’s a chance for recipients to try something new without risking the use of limited SNAP dollars,” says Devon Byrne, 4P’s account manager.

Health data is beginning to follow. Project Food Box participants showed a 1-point drop in A1C in a UC Irvine study, while 4P Foods reports significant reductions in BMI among children.

OVERCOMING OBSTACLES

While cost is often cited as the biggest barrier to eating more fresh produce, three other barriers continue to limit consumption. Eighty-three percent of U.S. adults surveyed by the Pew Research Center in 2025 said that taste is extremely or very important when deciding what to purchase. Over half (52%) cited the food’s healthiness, and 47% cited its convenience.

• Taste: Raising the Eating Experience. Flavor remains the first gatekeeper to repeat purchases. The U.S. Highbush Blueberry Council (USHBC), in Folsom, CA, points to continued advances in genetics and breeding that improve consistency and eating quality. “Decades of research have built blueberries’ health halo, but the eating experience still matters,” says Leslie Wada, PhD, RD, senior director of nutrition and health research.

At Stemilt Growers, in Wenatchee, WA, apples, such as Cosmic Crisp, illustrate how flavor-forward varieties can reinvigorate mature categories, says Brianna Shales, marketing director. “The variety rose from zero to No. 7 in the apple category in just six years, driven by high flavor, crispness, and storability.”

• What’s Healthy: From Research To Retail Decisions. Health messaging is most effective when it shows up where decisions are made. The California walnut industry leveraged clinical research on walnuts and heart health to earn the American Heart Association Heart-Check certification in 2011.

“For the last eight years, we’ve developed annual retail promotions for American Heart Month to translate health research into point-of-purchase signage, educational displays, recipe content, digital and social-media assets, value-added promotions, and media outreach, designed to make walnuts’ heart-health benefits clear and compelling,” says Jennifer Olmstead, senior director of U.S. marketing and communications for the California Walnut Board and Commission, in Folsom, CA.

Meanwhile, the National Watermelon Promotion Board, Winter Park, FL, takes a practical approach to turning watermelon research into real retail results.

“The science is translated into simple, consumer-friendly messages that show up in press materials, social media, retail kits and dietitian outreach,” says Juliemar Rosado, director of retail and international marketing. “Retail partners then bring these messages to life with POS signage, recipes, sampling tools, and staff training that help produce teams and retail dietitians talk about watermelon’s health benefits.”

Retail execution indeed brings the science to life. At Giant Food, a Produce Prescription In-Store Display program, developed with dietitian, merchandising, and vendor partners, creates a dedicated destination that highlights fruits and vegetables selected for their health benefits.

“Customers don’t need to work harder to make healthy choices,” says Katz. “Having a clear ‘healthy, try something new’ destination reduces overwhelm and encourages shoppers to add one more produce item.”

At Stop & Shop, a 365-store retailer based in Quincy, MA, retail dietitians focus on application. “Knowing something is good for you alone doesn’t cut it,” says Tina McGeough, MPH, RDN, CDCES. “What matters is connecting people to how a food fits their household.”

“Knowing something is good for you alone doesn’t cut it. What matters is connecting people to how a food fits their household.”
— Tina McGeough, Stop & Shop, Quincy, MA

• Convenience: Removing Friction. Time remains a persistent barrier to healthful eating, making convenience a priority.

Growers and retailers should understand the barriers and opportunities shoppers face today, says the IFPA’s Van Lieu. “At the end of the day, customers make choices based on what they can afford, what looks good, and what they know they or their family will eat within their current eating patterns. We need to deliver on price, but also flavor, convenience, and meeting cultural and nutritional needs.”