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Market to Mouth Coming Full Circle What do people do with foods purchased at a health center- based farmers market? Darcy A. Freedman, MPH, PhD Associate Professor, Department of Epidemiology and Biostatistics, Social Work Core Faculty, Prevention Research Center for Healthy Neighborhoods Case Western Reserve University Prevention Research Center for Health Neighborhoods Seminar May 14, 2014

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Agenda Rationale for integrating farmers markets/food access interventions into health care delivery systems Formation of Right Choice Fresh Start Farmers Market Outcomes Related to Right Choice Fresh Start Farmers Market Importance of Building Demand along with Supply Teamwork Activity (20 min) Discussion and Questions

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1 in 3 National Health Interview Survey participants who were chronically ill reported they were unable to afford food, medications, or both.

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Journal of Nutrition Diabetes Care Journal of Hypertension Journal of Nutrition Journal of Clinical Oncology

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Hippocrates (~460BC-370BC) Father of Western Medicine Medical Revolutionary Natural causes of disease (e.g., environment, diet, living habits) vs. punishment from gods Food as medicine philosophy

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Store Type (33 stores) Quality Composite Score (mean) Example Convenience Stores (70%) -0.74 Local Markets (24%) -0.38 Supermarkets (6%) 6.5 Composite score = sum of scores for access to fresh fruit, fresh vegetables, lean meats, low-fat milk, tobacco products, alcohol. Chronbachs alpha =.76 Source: Freedman & Bell, 2009

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Example literature showing relationship between food environment and diet, chronic disease: Liese, Weis, Pluto, Smith, & Lawson, 2007; Moore & Diez Roux, 2006; Morland, Wing, Diez Roux, & Poole, 2002).

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If you build it will they come? Columbia Food Fresh Market closed after 1.5 years