Health Care and
Food Partnership
VeggieRx: Windy City Harvest, Lawndale Christian Health
Center, Chicago Partnership for Health Promotion, Proviso
Partners for Health, PCC Wellness Center
CASE STUDY JANUARY 2020
Organizational
Overviews
Windy City Harvest (WCH) is an urban agriculture
initiative of the Chicago Botanic Garden, focused
on job training, building a local food system and
healthier communities, and contributing to the mission
to “cultivate the power of plants to sustain and enrich
life.” Windy City Harvest recognizes the power of
accessible green spaces and high-quality nutritious
food to impact physical, mental and social well-being.
Windy City Harvest specializes in food production,
food access, and urban agriculture job training
and education.
Lawndale Christian Health Center (LCHC) is a
Federally Qualied Health Center (FQHC) located
in the North Lawndale community area of Chicago
that is committed to “promoting wellness and
providing quality, affordable health care for
Lawndale and the neighboring communities.”
LCHC partners with Windy City Harvest on both
VeggieRx and the Farm on Ogden. The Farm on
Ogden, located across the street from the health
center, supports and sustains a healthy urban
community by bringing food, health, youth
development, and jobs together in one location.
Chicago Partnership for Health Promotion (CPHP)
is the Supplemental Nutrition Assistance Program
Education (SNAP-Ed) implementation agency for
the city of Chicago. The mission of CPHP is “to
provide high quality nutrition education and health
promotion programs, in partnership with SNAP
eligible individuals, families and communities in
Chicago.” CPHP led the development of the cooking
demonstrations and nutrition education for VeggieRx.
Proviso Partners for Health (PP4H) in partnership with
Loyola University Health System, and Loyola University
Chicago Marcella Niehoff School of Nursing is working
in Proviso Township to build capacity to address
racial, health, and economic inequities through
partnerships while leveraging community assets
and wisdom. PP4H partners with WCH to operate
VeggieRx in suburban Cook County.
PCC Community Wellness Center is an FQHC
comprised of 12 clinics serving the West Side of
Chicago and the near west suburbs. PCC’s mission
is to improve health outcomes for the medically
underserved community through the provision of high
quality, affordable and accessible primary health
care and support services. PCC partners with WCH
on both VeggieRx and the PCC Austin Farm. Located
within a food desert, the PCC Austin Farm brings
fresh, organic, sustainable produce to the West Side
of Chicago.
ALLIANCE FOR HEALTH EQUITY ALLHEALTHEQUITY.ORG CASE STUDY HEALTH CARE AND FOOD PARTNERSHIP: VEGGIERX 2
Partnership History
The VeggieRx program began as a partnership
between Windy City Harvest and Lawndale
Christian Health Center in 2016, with Loyola/
PP4H in 2018, and PCC launched a program in
June 2019. Windy City Harvest was looking to
enhance their ability to address food insecurity
and diet-related disease, as well as increase
demand for fresh, local food. For Lawndale
Christian Health Center, supporting improved
food access is an integral aspect of supporting
community wellness and working to foster a
healthy community. For PP4H and Loyola, the
partnership with WCH aligns with both the food
justice and economic justice aspects of their
work. PCC has integrated urban agriculture and
VeggieRx initiatives with their diabetes action
plan to address priority needs of the patients
and communities they serve.
VeggieRx Program
Operations
OV
ERVIEW
V
eggieRx provides participants with a bag of
produce, vouchers (“Produce Perks”) that are
redeemable for additional produce at onsite farm
stands, and a nutrition lesson and cooking
demonstration using produce participants are
receiving that week, with samples. The cooking
demonstration is used to spark discussion on
healthy cooking and nutrition.
I
n 2019, Windy City Harvest collaborated with three
healthcare partners to operate VeggieRx: LCHC’s
Farm on Ogden in North Lawndale, in Maywood with
PP4H and Loyola (this site operated in Elmwood
Park in 2018), and in the PCC Farm in Austin. WCH
also worked wtih West Side United to pilot programs
with two additional healthcare partners- Rush and
Sinai health systems. The VeggieRx programs run
from June through November as this is when local
produce is available.
Maywood, IL North Lawndale
(CHICAGO, IL)
South Lawndale
(CHICAGO, IL)
Austin
(CHICAGO, IL)
Total population (2016, 5-year estimate) 24,029 35,423 73,983 97,611
Largest population 70.9% African American 87.8% African American 84% Hispanic or Latinx 81.6% African American
Median Household Income $44,126 $26,076 $31,697 $32,492
Individuals below poverty level 20.9% 44.8% 34.8% 30.3%
Food stamps/SNAP participation 34.4% 51.4% 36.9% 35.2%
Risk for food insecurity 37.6% 37.4% 44.6% 51.6%
Source: 2012-2016, 5-year estimates American Community Survey (U.S. Census Bureau)
COMMUNITY SNAPSHOTS
ALLIANCE FOR HEALTH EQUITY ALLHEALTHEQUITY.ORG CASE STUDY HEALTH CARE AND FOOD PARTNERSHIP: VEGGIERX 3
PARTICIPANTS
The majority of VeggieRx participants live in
and around Lawndale, Austin, and Maywood
where the program sites are located. The
program is focused on serving low-income
households that are at risk for food insecurity.
At the LCHC “Farm on Ogden” site, approxi-
mately 60% of the VeggieRx participants are
African-American, and 40% are Hispanic/
Latinx, and the nutrition and cooking classes
are offered in both English and Spanish.
One challenge is assuring access to the full
program for individuals who do not have a
Link card (Illinois’ Supplemental Nutrition
Assistance Program [SNAP] benets), partic-
ularly individuals that are undocumented (see
“Lessons Learned and Recommendations” on
page 7).
Participants who are referred into the program
are given a “veggie prescription” by their health
care provider which includes the date, time,
and location of the next VeggieRx distribution
event. When the participant arrives at the event,
Windy City Harvest registers them into the
program. VeggieRx sessions begin with
a nutrition class and cooking demonstration.
Following the class, each participant receives a
bag of produce grown by Windy City Harvest to
take home, and $10 in “Produce Perks” that can
be used to match purchases from their Link
card at an onsite farm stand. Participants are
encouraged to come to VeggieRx up to 10
times per year. For 2019, there has been one
weekly distribution per site in Maywood
and Austin. VeggieRx has run twice weekly
distributions in North Lawndale since 2017.
VeggieRx is largely funded by the United
States Department of Agriculture (USDA)
through a Food Insecurity Nutrition Incentive
(FINI) grant. This grant began in 2016 with
a two-year pilot that was subsequently
extended through 2021. Health care organiza-
tions support VeggieRx through staff time and
provision of space and onsite logistics for
VeggieRx distribution events. CPHP developed
the nutritional education, cooking demos and
recipes for VeggieRx distributions. Other
supplemental funding has been provided by
the American Heart Association through PP4H,
Loyola University’s health equity grant, and
PCC Wellness Center’s foundation to provide
boxes for qualifying patients who do not have
an active Link card. The Humana Community
Benet Fund provided the funding to start the
PCC Austin Farm in 2014.
COMMUNITY ENGAGEMENT
Consumer feedback is instrumental in shaping
the strategies of VeggieRx. Participant prefer-
ences drive what is included in the weekly
produce bags and what is sold at the farm
stands. Feedback was also the impetus for
the way the classes are now scheduled at the
North Lawndale site. VeggieRx was piloted
with a cohort model, but both the participants
and LCHC found that classes which facilitate
participants dropping-in when it suits their
schedule is preferable. Additionally, Windy City
Harvest and LCHC added an evening class for
those who could not make it during the tradi-
tional workday. To build on the feedback model
and engage community members beyond those
currently participating in VeggieRx, Windy
City Harvest and LCHC have employed a few
different strategies. Windy City Harvest reports
it was helpful to follow-up with those who were
referred to VeggieRx but came rarely or never
came to determine what was not working for
them. However, staff time limitations have made
it difcult to make this practice consistent.
ALLIANCE FOR HEALTH EQUITY ALLHEALTHEQUITY.ORG CASE STUDY HEALTH CARE AND FOOD PARTNERSHIP: VEGGIERX 4
One of the unique aspects of VeggieRx is the
way it is integrated and overlaps with existing
farms, programs and healthcare partners.
VeggieRx is integrated and valued throughout
Windy City Harvest. WCH Youth Farm students
grow the produce for and run the farm stand in
North Lawndale. WCH Harvest Corp
participants help to grow much of the produce
for VeggieRx bags and assist with VeggieRx
distributions. The North Lawndale VeggieRx
Program Assistant is a graduate of the North
Lawndale Youth Farm and lives down the street
from the Farm on Ogden. Additionally, each
VeggieRx distribution site has a farm nearby.
This helps to bring visibility to the program and
strengthen participants’ under-standing of the
seasonality of the produce.
ORGANIZATIONAL ROLES
For the North Lawndale site, Windy City Harvest
provides the program administration and the
produce – both the weekly bags and the food
for purchase at the farm stands. This is how
the Austin site operates as well. On the other
hand, PP4H runs the farm stand in Maywood
with produce grown at their Giving Garden.
Some of the vegetables are grown from the
farms on site, but produce is also aggregated
from multiple Windy City Harvest farms. For all
the sites, the health care organization takes
the lead on screening and referring patients
to participate in the program and provides the
physical space for the program to operate.
All the health care organizations use the
2-question Hunger Vital Sign™ screening tool
1
and provide a “veggie prescription” via their
electronic medical record (EMR). Screening
and participation criteria vary slightly among
the health care partners. For example, LCHC
identies patients who are experiencing food
insecurity, have an active Link card, and have
a diet-related chronic disease. While PCC
specically prioritizes patients with diabetes.
For the programs in the City of Chicago,
LCHC in North Lawndale and PCC in Austin,
1
Hunger Vital Sign
™
screening tool: http://childrenshealthwatch.org/public-policy/hunger-vital-sign/
Nutrition Peer Educators from CPHP provide the
nutrition education and cooking demonstrations.
For the PP4H program in Maywood, suburban
Cook County, a Loyola registered dietitian and
dietetic interns provide the nutrition and
cooking education.
The clear roles for each partner allow the
program to run effectively and sustainably;
however, successful implementation at each
site hinges on trusted relationships between the
health care organization, Windy City Harvest,
the nutrition education provider, and program
participants. The partners have worked together
to adapt and evolve the program over time (see
“Lessons Learned and Recommendations” on
page 7). In the case of the North Lawndale
VeggieRx program, which has been operating
the longest, the team at Windy City Harvest
sends the LCHC medical providers weekly
summaries of who participated in the program
and what they received during their visit. The
summaries support the providers in staying
involved with the happenings of VeggieRx
outside of the clinic, and how their patients are
benefitting.
ADAPTATIONS OF THE MODEL
In January 2019, Lil VeggieRx was piloted in
Maywood through the partnership between
PP4H, WCH, Loyola University Health System,
Loyola University Chicago and the American
Heart Association to provide a produce
distribution, along with cooking
demonstrations and nutrition lesson to 30
SNAP participants, as well as an additional 65
residents of Maywood, Broadview, Melrose
Park, and Bellwood over the course of 10
weeks. Programs are facilitated by Loyola
Dietetic interns and by medical students
enrolled in a Culinary Medicine elective.
In 2019, PCC began implementing an
adapted version of VeggieRx. They coupled
the VeggieRx program with a group medical
visit. Aligning with the drop-in model, PCC
Each
VeggieRx
distribution
site has a
farm nearby,
bringing
visibility to the
program and
strengthening
participants’
understanding
of the
seasonality of
the produce.
ALLIANCE FOR HEALTH EQUITY ALLHEALTHEQUITY.ORG CASE STUDY HEALTH CARE AND FOOD PARTNERSHIP: VEGGIERX 5
paired the VeggieRx curriculum with an
education session for patients with diabetes.
The education session was facilitated by a
PCC medical provider, a registered nurse and
a social worker. It is PCC’s vision to develop
a long-term, sustainable program built on
the partnership of VeggieRx and a medical
reimbursement model. This pilot project aligns
with PCC’s diabetes action plan, in which the
purpose is to implement programming that
will provide long-term impact in the treatment
and management of diabetes. Because of
the community PCC serves, this is a priority
population.
EVALUATION
Data collection for VeggieRx includes
participant demographics, frequency of
participant attendance, records of health
care provider participation, food distribution,
and self-reported consumption and behavior
change. Demographic data collected includes
participant age, race/ethnicity, family size, and
patient status. Records are kept on how many
patients are being served, as well as which
providers are taking part in referring those
patients. For food distribution, information is
collected on the number of bags distributed,
in addition to what proportion of those bags
the participants are using. The redemption
rate of Produce Perks for each farm stand
and for individual participants is also tracked.
To measure behavior change, VeggieRx
participants are asked to complete a fruit and
vegetable checklist on their rst, fth and tenth
visits. Windy City Harvest and their health care
partners are currently exploring additional
evaluation methods to understand impacts on
health and quality of life for the participants.
Impacts and Benets
During the operational season from June –
November, VeggieRx serves a total of
approximately 200 people per month. The
majority of participants are low-income, African
American and Hispanic/Latinx. In Cook County,
these demographic groups have historically
VeggieRx helps our neighbors to understand so
many things we need to know to live a healthier
lifestyle. They do not just stop there, at the end
of each class; they give out a FREE produce
bag and produce perks… The Farm on Ogden
and Windy City Harvest is something that is
honestly life changing. The amount of people I
see shopping, attending the classes, signing up
for programs is just remarkable. It is something
that I am proud to have in my community and
something that is making a huge difference.”
I appreciate the box and the program. The
box helps me to provide good nutrition to my
kids and myself and I’m thankful because it’s
expensive to eat healthy. I can’t afford to eat
healthy as often as I’d like because of the
prices and availability in my neighborhood. The
program gives me valuable information that I
can understand and incorporate in meals at
home for my family.”
–VEGGIERX SURVEY
The following have been lightly edited for spelling and grammar.
IMPACT TESTIMONIALS
ALLIANCE FOR HEALTH EQUITY ALLHEALTHEQUITY.ORG CASE STUDY HEALTH CARE AND FOOD PARTNERSHIP: VEGGIERX 6
–VEGGIERX SURVEY
been underserved and are disproportionately
burdened by poor health outcomes. In 2018,
763 produce bags were distributed in North
Lawndale in partnership with LCHC, and 186
were distributed in Elmwood Park and Proviso
Township in partnership with PP4H and Loyola.
Among participants at the North Lawndale site,
VeggieRx saw a 18% increase in the number of
people who reported eating two or more cups
of vegetables per day, the lowest end of the
range recommended for adults by the Dietary
Guidelines for Americans. Through VeggieRx,
patients who are identied as food insecure are
given a tangible way to access healthy foods
which may otherwise be unfamiliar, unattainable
and/or unaffordable.
Partnering to implement VeggieRx also
benets the food and health care organizations
involved. Each organization provides expertise
that the others may struggle to deliver as
effectively on their own. Windy City Harvest has
the knowledge and skills around food access
and urban agriculture. VeggieRx helps Windy
City Harvest fulll their mission to allocate a
substantial portion of the produce they grow
to residents of the communities their farms
are located within. In addition to providing
a convenient space for the program, the
health care organizations identify and refer
the patients who may be able to benet the
most. VeggieRx empowers the providers with
a concrete program to refer their patients with
food insecurity to. CPHP brings nutrition and
cooking knowledge and skill, and VeggieRx
gives them a consistent gathering of their priority
population with SNAP benets to work with.
Lessons Learned and
Recommendations
•
E
x
e
c
u
te the referral through the Electronic
M
edical Records (EMR). Including referrals to
VeggieRx in patient’s EMR and exit paperwork
adds weight to its importance. It connects the
program to the patient’s care plan and health
goals they are setting with their provider.
•
Be flexible in program implementation. Windy
City Harvest and LCHC changed the structure
of classes in North Lawndale to allow partic-
ipants to come to any food distributions that
t their schedule. On the other hand, PCC
is piloting a more structured model with
more individualized support to participants
(patients with diabetes) because it is better
suited to the work the organization is already
doing. Both models function to address food
insecurity, but they are adapted to meet the
needs of participants and partners.
•
Partnering to serve SNAP recipients is a
win-win and must also include supple-
mental funding to serve individuals who are
undocumented. The majority of food
insecure patients that health care providers
want to serve are eligible for SNAP, which
I’m totally in love with the
program. Most grateful
because I love veggies
and fruit.”
–VEGGIERX SURVEY
The bag of veggies helps me
because I don’t have extra
money to help with cooking
healthy foods.”
–VEGGIERX SURVEY
We’ve been able to lose/
maintain our weight goals
set by doctor for our family
and reduce/stop much of
our medicine because we’ve
changed our habits because
of fresh veggies. Thank you!”
–VEGGIERX SURVEY
Increase in
the number
of people
who reported
eating two or
more cups of
vegetables
per day:
18%
ALLIANCE FOR HEALTH EQUITY ALLHEALTHEQUITY.ORG CASE STUDY HEALTH CARE AND FOOD PARTNERSHIP: VEGGIERX 7
present great opportunities for partnership.
Programs like VeggieRx that are funded
through the USDA’s FINI program must look
for supplemental ways to fund undocumented
community members or anyone else who is
not SNAP-eligible. Windy City Harvest and
the health care partners have taken a few
different approaches to providing access
for the undocumented population - PP4H
secured funding from the American Heart
Association and PCC secured funding from
their foundation to cover participants without
Link cards.
•
Ensure there is a staff member at the health
care organization who can serve as a liaison
and champion for VeggieRx. VeggieRx has
found that having someone from the health
care organization who is well-connected
to the program is essential. This person
has access to the EMR, can follow-up with
referred patients, knows the logistics of the
program for patients and providers, and
can connect all the pieces to ensure smooth
program implementation.
Future Directions
Moving forward, Windy City Harvest and their
partners would like to bolster evaluation to
better understand the efficacy of VeggieRx and
its impact on participants. Beyond evaluation,
considerations of how to strengthen and grow
VeggieRx in years to come revolve around
sustainability. One potential opportunity for
VeggieRx is to make it a year-round program.
Currently, the program runs from June –
November as this schedule corresponds with
the local growing season. While providing local
produce is an important strength of the
program, this unfortunately means participants
are without the fruits and vegetables they
receive from VeggieRx from December – May.
Windy City Harvest is investigating possible
supply chains that could allow the program to
operate all year. Another aspect of VeggieRx’s
sustainability is the funding system. The
program is currently funded by the USDA FINI
grant, in addition to funds secured by partner
organizations. However, this means financial
support for VeggieRx is subject to the uncer-
tainty of philanthropy and funding cycles. Windy
City Harvest is exploring ways to integrate
program support into existing funding systems.
Finally, Windy City Harvest is considering how
to support geographies not currently served by
VeggieRx. One potential piece of this could be
Windy City Harvest’s urban agriculture
programs which offer paid opportunities for
individuals to become trained urban farmers.
Hopefully, some of the individuals who go
through these programs and start their own
farms will be able to join partnerships to help to
serve people with food insecurity in their
communities.
ALLIANCE FOR HEALTH EQUITY ALLHEALTHEQUITY.ORG CASE STUDY HEALTH CARE AND FOOD PARTNERSHIP: VEGGIERX 8
Fournier, E., & Calendo, B. (2019, March 1). Windy City Harvest Case
Study Interview [Personal interview].
Chicago Botanic Garden Mission and History.
https://www.chicagobotanic.org/info.
Chicago Partnership for Health Promotion About Our Program.
https://cphp.uic.edu/about-our-program/our-program/.
Hertenstein Perez, J., Fournier, E., Sianghio, A., Foltz, P., & Brooks, A.
(2019, March 1). [Food Access and Health Care Partnerships Landscape Scan].
Unpublished raw data.
Lawndale Christian Health Center About. https://www.lawndale.org/about.
Proviso Partners for Health http:www.provisopartners.com/about-us.html.
2012-2016, 5-year estimates American Community Survey (U.S. Census Bureau)
https://www.census.gov/programs-surveys/acs/.
REFERENCES
ALLIANCE FOR HEALTH EQUITY ALLHEALTHEQUITY.ORG CASE STUDY HEALTH CARE AND FOOD PARTNERSHIP: VEGGIERX 9
PCC Wellness Overview. http://www.pccwellness.org/about-us/overview.
