Growing health: Building partnerships in healthcare and food systems for improved food access in Appalachia

Hospitals not only provide access to healthcare services in rural areas; they also serve as major employers and economic drivers. The goal of this pilot study was to improve our understanding of how a rural healthcare system in Appalachian Kentucky could be leveraged to expand access to fresh fruits and vegetables. We conducted 11 semi-structured interviews with food system and healthcare stakeholders in Hazard, Kentucky, to (1) improve our understanding of key barriers to accessing and utilizing fresh produce for healthcare worker and patient populations, (2) identify models for direct-to-consumer market channels and farm-to-institution programming in collaboration with a local hospital, and (3) explore the potential of those models to foster greater consumption of fruit and vegetables among community members. Stakeholders emphasized the need for staff support and funding during program development and discussed the difficulty in maintaining prior local food and health promotion efforts when pilot funding expired. Other considerations included the importance of community ownership, robust communication and coordination among stakeholders, and attunement to the opportunities and challenges of a hospital-based approach. Direct farm-to-consumer models were considered feasible but would require accommodation for low-income consumers, such as vouchers, sliding-scale payment methods, or “double dollar” programs. Farm-to-hospital initiatives were discussed in the context of the COVID-19 pandemic and reduced hospital cafeteria usage, which may limit the success of some events but highlights the potential for to-go options such as pre-prepared salads, lightly processed snacks, and medically tailored meal kits. Results of this study illustrate the challenges and opportunities of leveraging a rural hospital as an anchor institution for expanding local food system development in rural Appalachia. This study also offers insights into the intersections of health, culture, and economy in an Appalachian community, and provides a framework for expanding local food system initiatives.