Fresh Bucks program linked to higher food security, fruit and vegetable consumption in low-income households

Households receiving financial support to buy healthy foods in Seattle, Washington, US, experienced 31% higher food security than those not in the program. Participating households were also 37% more likely to consume at least three daily servings of fruits and vegetables than people on a waiting list. This initiative is open to households with less than 80% of the area’s average income.

The program’s success underscores the importance of financial support to reduce food insecurity and improve diet quality. The findings are timely as the US government recently made substantial cuts to the federal food stamp program. 

The Fresh Bucks program provides recipients a monthly voucher of US$40 to purchase fresh, frozen, canned, and dried fruits and vegetables at 38 retail locations in Seattle, including farmers’ markets and grocery stores. 

In a study evaluating the program, researchers compared applicants receiving the monthly benefit with households assigned to a waiting list when the total number of applicants exceeded the 2022 program funding.

Co-author Jessica Jones-Smith, a University of Washington (UW) affiliate professor of health systems, population health, and epidemiology, says the increase in food security and produce consumption is “pretty large.” 

“We don’t routinely see interventions that work that well. It’s a big impact on diet in terms of what we can do from a policy perspective and expect to make a difference in food insecurity.”

Fresh Bucks

In October 2021, the Fresh Bucks program received 6,900 applications — new applicants and returning beneficiaries — for benefits in 2022. As these exceeded available funding, the administrators randomly assigned 2,700 households to a waiting list. 

The study, published in JAMA Network Open, includes data from 1,973 households, on either a waiting list or in the program, who completed and returned surveys. 

Households in the Fresh Bucks program can spend US$40 per month on fresh, frozen, canned, and dried fruits and vegetables at Seattle locations.Within this sample of households, the researchers randomly assigned a group to disenroll from the program after six months and compared the outcome of losing benefits to households continuing to receive benefits. 

Losing the Fresh Bucks benefits lowered food security by 29%, while these households were also 26% less likely to eat fruits and vegetables at least three times a day. 

“The results were quite symmetric,” says Melissa Knox, lead author and UW teaching professor of economics. “The people who gained the program saw nearly the same benefit as what was lost by the people who lost the program. So, it seems like two things are going on: One is that the program is helping people, and the other is that these effects don’t magically sustain themselves without funding.”

Jones-Smith agrees that money or material resources are necessary to improve diet quality. “We clearly see that once this program goes away, people can no longer afford to eat these foods.”

Food security health benefits

The researchers note that a lack of access to nutritionally adequate foods is often linked to lower-income households and associated with poor nutrient intake and a higher prevalence of chronic diseases, like diabetes and hypertension. 

Although improving diet quality, specifically by increasing the consumption of fruit and vegetables, has been linked to lower chronic disease risk, fresh fruits and vegetables tend to be less available in lower-income neighborhoods and more expensive than processed options. 

“The UW’s study helps us understand how the City of Seattle’s Fresh Bucks program shows up in the day-to-day decisions of our enrolled households,” comments Robyn Kumar, Fresh Bucks program manager at the City of Seattle Office of Sustainability. 

Kumar underscores how the program offers a tangible difference for households in food security and fruit and vegetable intake.“Findings show that the healthy food access program makes a tangible difference for customers, significantly increasing food security and fruit and vegetable intake. We know these lifestyle changes have long-lasting benefits, and Fresh Bucks is helping to ensure that our most overburdened community members have equitable access to healthy foods and increased quality of life.”

Food is Medicine

In addition to the Fresh Bucks program, research links produce prescription programs to similar successes. These initiatives provide free fruits and vegetables to participants. 

Produce prescription programs are exemplary initiatives in the growing Food is Medicine movement, highlighting how nutrition-based interventions can complement medical treatment and help prevent chronic diseases.  

Surveys indicate strong support for these programs among US consumers, with nearly nine in ten patients saying they prefer to rely on healthy eating rather than medications to manage their condition. 

Other interventions include improving food security through nutrition programs like the Supplemental Nutrition Assistance Program (SNAP) and medically tailored meals. Registered dietitians design these meals to meet the nutritional needs of people with complex health conditions. Research indicates that implementation across the US could save around US$32 billion in the first year. 

The Fresh Bucks organizers underscore that their program differs from other healthy food benefit programs, as it focuses enrollment within households disproportionately impacted by food insecurity and diet-related chronic disease. 

It does not require SNAP eligibility and enables participants to redeem benefits at large food retailers and smaller local stores. Moreover, no match spending is needed, where participants receive additional benefits based on how much of their money they spend.