When Doctors Prescribe Food
In Hawaiʻi, more than 100,000 low-income residents who qualify for Medicaid may soon receive an unusual "prescription" — not pills, but fresh fruits, vegetables, and even ahi, beef, chicken and eggs. The federally funded "Food Is Medicine" initiative is expected to launch as soon as January, aimed at addressing chronic diet-related health issues in low-income communities.
Why Food Prescriptions?
One in three households in Hawaiʻi has limited access to safe, affordable and nutritious food. On the Big Island, 43% of residents report food insecurity; about half of Native Hawaiians and Pacific Islanders are food insecure and suffer the diet-related health consequences.
Conventional medicine has long turned a blind eye to the importance of nutrition, but its influence on health has been gaining greater attention with the rise in obesity and diet-related illness globally. Advocates in Hawaiʻi hope the move will help ensure lower-income communities have sufficient, nutritious food and that patients are well-versed in healthy eating.
Real Cases: Blood Sugar Halved, 70 Pounds Lost
Big Island residents Moses and Suzette Paio have struggled with diet-related health issues for years. Their home in Puna is classified as a food desert — a location with limited or no access to affordable, fresh, healthy food.
"It's not that I don't want to buy it," Suzette Paio said, "it's just that I can't."
They took part in a pilot program rolled out this year under the Medicaid waiver, receiving five months of weekly produce and protein boxes delivered by The Food Basket, Hawaiʻi island's food bank. The results were striking:
- Suzette Paio's average blood sugar has halved, something she had struggled to control for more than a decade;
- Moses Paio lost over 70 pounds;
- They started gardening, preserving food, and getting more active.
Local bananas and papayas "are my candy," said Suzette Paio, having replaced cheaper sugary treats she used to enjoy.
Local Sourcing: A Win-Win
What sets the program apart is that advocates recommend at least 15% of all produce and protein comes from local sources. It's not binding, but it's an aspiration reflecting support for local agriculture.
"It's a lot of work to bring together a broken healthcare system and a broken food system, and asking them to work together," said Jordan Smith of Hawaiʻi Good Food Alliance. Sourcing food from the continent is certainly easier, but healthcare providers are resolved to stay as local as possible. Otherwise, the food is mostly "coming across the ocean on a boat, it's not fresh, it's not necessarily culturally relevant," Smith said.
The program could inject millions of dollars into the local economy and create almost 1,000 new jobs.
Data and Prospects
At the Waiʻanae Coast Comprehensive Health Center in West Oʻahu, nutritionally focused healthcare programs have been operating since 2017. During the Covid-19 pandemic, the center tracked almost 500 Medicaid patients over 18 months who received a $60 monthly produce prescription. It resulted in about $118 in healthcare savings per patient, per month.
The University of Hawaiʻi is conducting a five-year study on the program's influence on hypertension. Assistant professor of nutrition Monica Esquivel, who is leading the study, says much more data will come as the program develops, but its premise is proof of a growing recognition of diet's influence on health.
Hawaiʻi will join at least a dozen states in implementing the nutrition scheme. The state's program will be rolled out in three phases, starting in January with nutritional education programs and prescription food boxes for eligible patients.
Daily Health Management Tips
For those concerned about blood sugar, blood pressure and weight management, self-monitoring is just as important as medical intervention. Regularly tracking diet, exercise and physiological indicators helps you spot changes early and communicate with your doctor. The Xiaoshu Health App can sync with Apple Health to track relevant metrics, helping you manage blood sugar, blood pressure, weight and other health data more conveniently — so the effects of dietary intervention become visible.