When she went to La Clinica de la Raza health center in Oakland for a routine checkup, the 54-year-old immigrant told her doctor she was under a lot of stress. Work had begun to dry up for her husband, a day laborer, and money was tight. Marta, who asked to be identified by a first name only, has chronic diabetes, and the doctor noted her high blood pressure. So the physician gave her an unexpected prescription: a $10 voucher for locally sourced produce, which Marta could redeem at La Clinica’s monthly food distribution.

The prescription was her gateway to what organizers call a food pharmacy — a new program aimed at improving the health of low-income patients in Alameda County by connecting them with fresh produce.

Unfolding in the backyard of the local food movement, these pharmacies are part of a new push to bring produce into primary care. The goal is to stave off poor health outcomes and reduce nutrition-related diseases like diabetes and hypertension. Instead of farm to table, you could call it farm to clinic.

“I think medicine is trying to grapple with social determinants of health now in a way that it never did before,” says Dr. William Chen, chief medical officer at ALL IN Alameda County, a county-wide effort to combat poverty. “There’s many social determinants of health: housing insecurity, food insecurity, transportation insecurity. Food insecurity is something you can do in the clinic. It’s a low-hanging fruit that has lots of upsides.”

La Clinica’s food pharmacy is part of what experts and organizers say is a burgeoning “food is medicine movement” unfolding nationwide amid a growing consensus that access to fresh produce can improve the health of underserved communities. It’s an approach that’s gaining traction across the country, with clinic-based food pharmacies popping up in recent years everywhere from Philadelphia to Houston.

The Bay Area has been at the forefront of the movement. In 2016, San Francisco piloted a food pharmacy program that has since expanded to 10 clinics across the city and Marin County. The South Bay launched its first food pharmacy the same year of out the Samaritan House Free Clinic in Redwood City. Alameda County’s program now has five pharmacies under way at La Clinica, Hayward Wellness, Native American Health Center, West Oakland Health Center and Roots Community Clinic, with plans for several more in the coming year.

The door of the food pharmacy invites guests inside during its grand opening at the Samaritan House Free Clinic in Redwood City, Calif., on Wednesday, Jan. 27, 2016. Samaritan House, the Second Harvest Food Bank and the Sequoia Healthcare District opened the first known food pharmacy in California to help low-income diabetes patients gain access to free nutritious food. The artwork was done by students of local schools. (Gary Reyes/Bay Area News Group) 

Alameda County’s initiative was Chen’s brainchild and is part of County Supervisor Wilma Chan’s “new war on poverty,” a multi-pronged effort launched in 2014. The initiative hopes to improve health outcomes for the county’s most economically disadvantaged residents by making it easier to get fresh, healthy food — often a barrier for people living paycheck to paycheck.

Experts say the need in Alameda County is profound. According to a recent report by the Alameda County Food Bank and the Urban Institute, roughly 1 in 5 people are either food insecure or at risk of hunger. Yet nearly half of those residents make too much money to qualify for food stamps.

That gap brings many of the hungry and those struggling with health issues to food banks such as Alameda County’s, where 20% of the households it serves have at least one member with diabetes and 39% have at least one member with high blood pressure. But organizers say food banks don’t have a doctor on-hand to advise clients on eating habits to manage certain health conditions.

That’s where food pharmacies come in.

At the health centers where they operate, providers screen patients for food insecurity at routine checkups and then prescribe a list of produce to address their specific health needs, from hunger to diabetes, obesity to hypertension. Patients can then take their prescription vouchers and use them to pick up $10 of locally sourced produce at the clinic’s monthly food distribution.

The produce is provided by Dig Deep Farms, a San Leandro-based farm that offers paid internships to formerly incarcerated youth and adults. The Alameda County Food Bank provides additional food, and patients who want more than the $10 of produce can use food stamps to buy from Dig Deep.

Canned tomatoes at the “food pharmacy’ at the San Antonio Neighborhood Health Center in Oakland. (Aric Crabb/Bay Area News Group) 

Chen, who has a background in integrated medicine, was tapped to run the program after introducing a smaller-scale food pharmacy program at the Hayward Wellness Center. Chen, who had a background in integrated medicine, saw an opportunity to integrate food into primary care to help manage and prevent chronic illnesses and hunger. In August, he moved from Hayward Wellness to ALL In to implement the food pharmacy model across the county.

La Clinica’s food distribution draws local volunteers through a program that gives community members the opportunity to educate patients on healthy eating and cook a meal using produce passed out at the distribution. At a recent event, one volunteer ladled out spoonfuls of spicy chayote squash. “Try the recipe we made for you today!” she said to each patient.

Dora, a 63-year-old Oakland resident who asked to use her only first name because of concerns over her immigration status, grabbed a bowl and drizzled the squash with a splash of lime. She is diabetic, unemployed and struggling to find work.

At a visit to La Clinica a few months ago, she told her doctor she has affording food. Her physician wrote her a prescription to La Clinica’s food pharmacy and she’s been coming faithfully for the past four months.

“This helps me so much, what they give me, especially when I have no job,” she said in Spanish.

La Clinica last week celebrated the one-year anniversary of its food pharmacy. Natalia Solano-Rojas, a registered dietitian at La Clinica, said 80 families typically use the distribution each month, and often line up early — rain or shine — to fill their grocery bags and carts with vegetables.

“They’re pretty excited about it,” she says.”I think having it here in the clinic and seeing people that they know and are familiar with makes them a little more comfortable to come get food.”

For Marta, the extra produce helps her family get through when her husband’s paycheck will only stretch so far. She left with two grocery bags brimming with vegetables — squash, herbs, celery and fruit.

“I was very happy when I learned about this,” she says. “Because now that we have less work, we can still feed ourselves. And that’s a blessing for my house.”

This article is part of The California Divide, a collaboration among newsrooms examining income inequity and economic survival in California.