The Mississippi Delta makes a fitting setting for an ambitious research project testing the premise that promoting access to fresh, nutritious food can improve health for people with chronic disease.
It was there -- in Mound Bayou -- where the godfather of the food is medicine movement, the late public health advocate Dr. Jack Geiger, co-founded the historic Delta Health Center in 1967, one of the first community health centers to open under President Lyndon Johnson's War on Poverty.
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This rural, low-income and majority-Black section of northwestern Mississippi now is the testing ground for the first-ever randomized clinical trial of a food prescription program targeting diabetes patients. It begins this month and is slated to run for one year.
If successful, the landmark, National Institutes of Health-funded Delta GREENS study could provide evidence to government health programs and health insurance companies that they should reimburse providers for integrating fresh food into the healthcare delivery system.
Food distribution pilot programs have gained in popularity among insurers and providers seeking to prevent adverse health outcomes and meet social needs for low-income patients. But these efforts lack sustainable financial support, which has limited their size and impact.
Delta GREENS — short for Growing a Resilient, Enriching, Equitable, Nourishing food System — further aims to establish a local food economy in the Mississippi Delta. The project is a collaboration between the Friedman School of Nutrition Science and Policy at Tufts University, the Reuben V. Anderson Institute for Social Justice at Tougaloo College, Delta Health Center and the Center for Science in the Public Interest.
The study participants forged alliances with regional farmers, who will supply fresh fruit and vegetables to patients with diabetes via the community health center.
The goal is to improve health outcomes and tackle food insecurity in rural Black communities, which face social, political and economic barriers to health that trace back to slavery. Positive results could facilitate food is medicine becoming a benefit under Mississippi's Medicaid program, said Julian Miller, the project's co-investigator and assistant professor of political science at Tougaloo College, a private, Christian, historically Black institution.
Prescription food and health
When Geiger originated the food is medicine movement at the Delta Health Center, it served a predominantly Black community of the descendants of formerly enslaved people. Geiger prescribed food for patients to obtain from local grocery stores. The shops would then bill the clinic, which in turn would seek reimbursement from the government by categorizing the food as prescription medicine.
Then as now, the concept of prescribing food attracted criticism, Geiger said in a 2016 interview with Think magazine. His rejoinder to one antagonist in the 1960s was, "The last time I looked at my textbooks, the most specific therapy for malnutrition was food," Geiger told the publication from Case Western Reserve University, where he earned his medical degree. Geiger died in 2020.
Mound Bayou and the Mississippi Delta region still had high rates of poverty and chronic disease as of 2020, according to the most recent data from the Census Bureau and the Mississippi State Department of Health.
In Bolivar County, the rural, agricultural jurisdiction that includes Mound Bayou, 32% of residents lived at or below the federal poverty level in 2020, which was $12,760 a year for a single person and $26,200 for a family of four. Mound Bayou itself had a 46% poverty rate. Bolivar County residents suffered from some of Mississippi's highest incidences of diabetes, hypertension, chronic kidney disease and cancer in 2020, the Mississippi agency reported this year.
In addition, the area's population declined over recent decades, depressing the economy and forcing many businesses, including grocery stores, to close, said Robin Boyles, chief programming and development officer at Delta Health Center. Despite living on some of North America's most fertile land, Mississippi Delta residents confront escalating levels of food insecurity, she said.
"We serve many communities where, if you're going to get food, the only place you can go is down to the convenience store where there are lots of chips, sodas and fried foods. People truly lack access to consistent healthy fruits and vegetables," Boyles said.
Through Delta GREENS, the federally qualified health center is teaming up with Tufts University, Tougaloo College, the Center for Science in the Public Interest and local farmers to establish a food distribution program for patients with diabetes.
In 2022, the NIH awarded the partners $6.6 million to support fruit and vegetable production and consumption in the Mississippi Delta. The grant supports a one-year study of diabetes patients age 25 and older with food insecurity. Researchers will track hemoglobin A1C, blood pressure and lipids and behavioral markers.
Delta Health Center will handle food distribution and medical examinations, Tufts will manage the research analysis, and Tougaloo will coordinate with farmers and conduct policy and economic research on the program's effects on local communities.
The research partners collaborated with five local farms to increase capacity and production. Farmers received $1 million to purchase equipment, land and supplies. The growers make weekly deliveries to the health center's locations, from which patients can pick up food or have it delivered. The program offers enough food for a patient's entire household.
The community health center installed refrigeration units and appointed a coordinator to ensure patients receive food and undergo health exams. The clinic also created a nutrition education program that includes recipes and cooking demonstrations.
Delta GREENS established a food policy council of stakeholders from the counties it plans to serve. Miller said the council's role is to make the program sustainable and beneficial to the community. "They don't want just to get the money, spend three years doing research and then leave. We want to leverage this to build a sustainable food system," he said.
A sustainable food system
Regional conditions today trace back centuries to slavery and post-Civil War sharecropping, as well as the fight against the Civil Rights Movement in the 1960s, said Miller, a fifth-generation Mississippian from the Delta. This has driven persistently higher rates of chronic illness and mortality among Black Mississippians, he said.
"After the Civil War, the wealthy elite of Mississippi, the farm families of the Delta and the people on the coasts still committed to maintaining their hegemony in agricultural production and exports by exploiting the labor force," Miller said.
In nearby Leflore County in 1962, for example, the all-white board of supervisors withheld funding from the federal Commodity Supplemental Food Program that was intended for impoverished residents, 90% of whom were Black, according to an article published in the academic journal Food, Culture & Society in 2020.
Despite its status as a major agricultural center, the Mississippi Delta imports more than 90% of the food its residents eat, according to an analysis from the Tougaloo College commissioned by the Delta Fresh Foods Initiative, a local coalition working to build a sustainable food system.
Most local crops, such as cotton and soybeans, are grown for export. The farming methods and pesticides used to cultivate these agricultural products can reduce yields at smaller farms producing fruits and vegetables, worsening regional food insecurity, Boyles said.
"I watch the trucks when I'm coming to work in the morning that are heading west over to the Port of Rosedale to put the cotton and soybeans on the boat to go wherever they get to go," Boyles said. "One of the aims [of Delta GREENS] is to work with our Black farmers, in particular, because those are often the ones that are growing the fresh fruits and vegetables, to build their capacity," she said.
Tougaloo College researchers will conduct an economic analysis of the farmers' production, return on investment and regional impact. They will also investigate the efficacy of insurers and government programs reimbursing for food prescriptions. States are increasingly allocating Medicaid funds for social drivers such as food and transportation through waivers, which could facilitate payment to farmers for growing food that helps maintain health and reduce costs.
"With developing locally grown, sustainable food systems, we can develop a food economy in a more equitable way," Miller said.
