In a world where communities of color remain the most impoverished… and the most affordable foods are also the most deadly… food has become the most fatal club swung by structural racism. And nowhere else is the harm of the food desert more pronounced than in jails and prisons.
Even on your side of the wall, remedy is in short supply. You fight food insecurity with cheap foods and inadvertently fuel the plagues of modernity*. You try to feed your children better only to find you have invested in the wellness of garbage cans. Public education is rarely a match for the glitzy marketing schemes of trans-national corporations, or the decision architecture that food retailers deploy on every street corner and every food aisle. Public health campaigns constantly implode, fizzle, or backfire, in ways everyone saw coming… in ways no one saw coming.
The story will not be different in jails and prisons. Here, hearts are heavy, and deadly food is a last refuge. This is the ultimate proving ground for practitioners of public health.
In places like this… how do we simultaneously address food scarcity and cardiometabolic illness? How do we use food as a medicine, while also embracing the joy of eating? This is the question all food activists must ask themselves, whether they work on your side of the wall, or ours. And it is the question that inspired the Right 2 Heal (R2H) design theory.
The goal of R2H design theory is to reshape food environments throughout marginalized communities – urban, rural, and incarcerated – in order to heal people who are being harmed by poor access to food, and the poor quality of food to which they have access. Simply put, our goal is to provide Black, Brown, and poor White people with daily access to “Healing Food”.
We define Healing Food as food that is not just healthy, but also affordable, desirable, and satiating. Healthy foods are not healing to people who cannot purchase them, do not desire them enough to eat them, and are not satisfied after eating them. We emphasize, food must sate one’s appetite to be healing, because only foods that satisfy can reverse the Dorito Effect, free people from cycles of overeating, and support sustained recovery from food desert physiology.
In application, our strategy achieves the goal of making healing food accessible to all socioeconomic strata by coupling classic food assistance approaches, and novel Food-Is-Medicine (FIM) approaches, with solidarity economics, site-specific decision architecture, and dynamic lifestyle education.
Integrating this design approach into the California Model is critical because rates of cardiometabolic illness are elevated within communities of color,1 further elevated in prison populations,2 and dietary practice is increasingly recognized as a major factor in brain health and emotional wellbeing.3,4,5,6,7 The emergence of the field known as neuroimmunology has shaken the medical world with the revelation that the immune system is deeply involved with the central nervous system, and has illuminated causal pathways through which gut health can impact brain health.8 Hailed as an authentic paradigm shift in our model of the brain, the neuroimmunological view is forcing a rewrite of medical textbooks. This deeper understanding of the brain is also vindicating a spectrum of holistic lifestyle treatments – many of which focus squarely on dietary practice. This suggests the decisions we make when designing food components of the California Model will have impacts on the neuroplasticity of incarcerated brains, rates of recovery from substance abuse, and untold psychiatric destinies.
Application of our design approach here at San Quentin will entail creating a number of state funded food assistance programs, one of which will pay for itself in Year-1 of operations. And a number of co-ops (both consumer and worker-operated) that will secure their own start-up funds, and be responsible for maintaining financial self-sufficiency.
This report discusses the operational dynamics of the following programs:
A worker-operated, regenerative farming co-op that practices carbon-negative agricultural techniques, teaches solidarity economics, and generates agricultural products for distribution to local markets and to San Quentin residents.
A consumer food co-op/ café that operates a made-to-order food service and promotes healing food culture by way of convenience, cost reduction, and culinary art.
A universal food stipend that provides all incarcerated people with access to the proposed food co-op/ café.
An FIM program that further subsidizes healing foods for San Quentin’s most-ill residents, and reinvests all associated medical savings back into the quality of food served to all San Quentin residents.
Importantly, our proposed worker co-ops will help to subsidize healing foods for all San Quentin residents by donating portions of their harvests/revenue to the consumer food co-op. The consumer food co-op will, in turn, optimize the effect of our proposed FIM program. The synergistic effect of these combined programs will improve access to food for incarcerated people, without compounding the effects of the carceral food desert; and will improve the health of incarcerated people while also honoring diverse food cultures and the joy of eating.
Our strategy, if replicated across the state, would shift meaningful portions of California Department of Corrections and Rehabilitation’s (CDCR's) $Billion+ annual medical budget away from a reactive healthcare system, and into an ecologically regenerative, socially just, and clinically healing food system. The outcome would be the establishment of an integrative medical model in the carceral space.
The three sections of this report approximately correspond to the three phases of the program implementation scheme introduced in the main body report. Operational dynamics of our proposed programs are summarized in "program logics" charts, and further explored in text. Each section provides key background information in order to properly contextualize discussion of program operations.
Section 1 discusses prison co-ops as tools for reducing recidivism, and describes how nonprofit organizations will work with residents of San Quentin to build pilot co-op programs.
Section 2 discusses how FIM approaches work, why their advent could be a turning point in our struggle against metabolic illness, and describes how an FIM program could be adapted here at San Quentin. This type of program requires a greater period of advisory interface and logistical planning, so it is likely to be implemented in Year-Two or Year-Three.
Section 3 provides brief comments on the onus of tracking outcomes related not just to new food programs, but all aspects of this historic reform effort. CDCR's current IRB process is time expensive, so serious studies are unlikely to report findings until Year-Three.
The consumer co-op model and the worker co-op model are both important features of our health promotion strategy because they offer unique ways of promoting healing foods culture and reducing the cost of healing foods,9 but also because prison co-ops boost self worth, improve mental health, and reduce recidivism.10
Prison co-ops are thought to have reduced recidivism dramatically where they are operated in certain European nations,11 some African nations,12 and in Puerto Rico.13 Recidivism in Italy runs about 70-90%, but only among co-op non-participants.11 For the 10% of Italy’s prison population that does participate in prison co-ops, recidivism is 5%.11 This is impressive since Italian co-ops are not operated only in low-security prisons, but at prisons of every security level, even at maximum security facilities.10
There are no prison co-ops in the US, however the USDA recognizes co-ops as an important means of support for system-impacted people.14 Cooperative business models are gaining attention and support on both the Left and the Right,15 and are believed to be recession proof.16,17 Importantly, prison co-ops appear to be a means of satisfying calls for improved wages for incarcerated people, without saddling the state with divisive expenses. For these reasons we strongly recommend the California Model include a framework that fosters the formation of prison co-ops.
We recommend California adopt a “Nonprofit Custodianship” system similar to the “social co-op” system that is used to such great effect in Italy. In our proposed nonprofit custodianship system, 501c3 organizations enable the existence of prisoner-operated co-op enterprises providing fiscal sponsorship of worker-operated enterprises. The custodian organization upholds fiduciary and moral trust with the correctional department, the public, and elements of the social justice community; while also supporting incarcerated workers by connecting co-ops with start-up funding, budgets for construction of new facilities, and various levels of technical assistance. Custodians are responsible for providing workshops and trainings that educate incarcerated people about cooperative values and cooperative management approaches. In this system incarcerated workers are the principle financial beneficiaries, and custodians are required to honor the leadership and entrepreneurial agency of incarcerated people.
We believe that the agricultural, culinary, and consumer co-ops we propose for integration in the San Quentin experiment can be initiated without legislative action because this system can be operated within existing California law and San Quentin residents have relationships with ideal custodian organizations and philanthropic networks. However, if this custodianship system is rolled out to all CDCR facilities we strongly recommend experts be commissioned to design a selection and oversight process that includes social justice stakeholders in the vetting of potential custodians.
San Quentin includes in its lease over 400 acres of fertile, mostly unused land. The Mediterranean climate of the San Francisco Bay Area is conducive to agricultural enterprise and the Area provides ample market demand. This resource, and the land that surrounds most other California prisons, presents an opportunity to turn our carceral facilities into agricultural universities that train people in the regenerative farming practices that will help reverse climate change, and the solidarity economics that will lift up those we have long held down.
Agricultural co-ops are logistically workable at most, if not all, facilities because many prisons already issue “gate-passes” that allow incarcerated people to work outside prison walls, and the Design Team is expected to propose the return of work furloughs.
The co-ops’ achievement of financial self-sufficiency will be supported by a number of sound business ventures, including an aquaponics facility, a tree nursery, and a food forest.
Aquaponic cultivation is a space efficient and climate resilient means of producing a wide variety of agricultural goods, as well as fish. Our intention is to produce crops for sale and consumption, and native fish for restocking California's creeks and rivers.
There is a need for new tree nurseries in California and by supporting this market we can help restore California ecosystems and remove carbon from the atmosphere.
Food forests are carbon negative food solutions that take time to reach productive maturity, but they are not labor-intensive methods and once established they produce food for many years.
Apiculture and mycoculture also fit with our mission of responsible and regenerative agricultural enterprise. There is a need for regeneration of honeybee populations due to catastrophic rates of colony collapse.18 Some mushroom extracts have been found to protect against colony collapse.19 Producing these extracts may be a smart business venture unto itself, and would definitely help protect the colonies of a San Quentin apiary. Maintaining an apiary, and practicing methods of protecting it from colony collapse, would provide income, meaningful support to the local ecosystem, and would provide co-op members with knowledge and experience in a trade that is critical to the salvaging of our haggard biosphere.
It is rumored the Design Team’s paper will recommend expanding agricultural work programs throughout the state, but the social justice community will rankle at the creation of new prison farm programs unless farm workers are provided a minimum wage and workplace participation is voluntary.
Of all prison work programs that could be expanded, farm projects face particular difficulty in today’s political climate because anti-plantation rhetoric is being leveraged and has gained a degree of salience. Unfortunately, spending tax dollars to pay all incarcerated workers a minimum wage would be an immensely divisive and prohibitively expensive proposal.
Alternatively, externalizing the cost of wage increases by allowing incarcerated people to participate in farming co-ops would not only sidestep complaints related to cost, meritocracy, and morality but would also be likely to positively engage vocal elements of the Left that are presently underwhelmed and/ or sharply critical of the governor’s reform effort.
Another benefit of choosing the co-op solution is that cooperative businesses maintain a practice of providing material support to other cooperative businesses. Case in point, the incarcerated people here at San Quentin who are presently engaged in efforts to form a regenerative agricultural cooperative aspire to a model in which our co-op regularly donates a percentage of its harvest to the proposed café co-op. This will meaningfully reduce the cost of food for San Quentin residents, and further optimize the effect of any FIM program that delivers food assistance by way of the healing foods café.
If it were not for the trailblazing work of Jeanne Woodford, the first and only woman to serve as warden of San Quentin, SQ would not have undergone the renaissance that it has over the last two decades: Governor Schwarzenegger might never have put the “R” in CDCR, programs like the NPR-syndicated Ear Hustle and many other important prisoner-lead projects would not exist, and there’s a chance that the entire prison reform narrative in California would be so altered that the California Model might not have come to be. Some of her policy proposals were so ahead of the times that they are only now being considered for implementation as part of the California Model – for example, requiring correctional officers to address incarcerated people as “clients” rather than “inmates”.
Most residents of San Quentin who met Jeanne have long since moved on, but a few of the old timers still remember her with respect and we would like her name to be honored here on the yard she once cared for. We feel it is fitting and important that she is commemorated in the name of something that is created through the leadership of incarcerated people, so it is clear that she is remembered lovingly not just by people in green, but also by people in blue.
To insure Jeanne’s name will always be associated with the mission to heal, we propose naming the first prison food cooperative in the United States “The Woodford Café”.
It is assumed that the state will adopt the basic Norwegian food model – which consists of a grocery outlet, a food stipend that enables all residents to participate in the marketplace, and self-cook stations that enable incarcerated people to prepare their own “home cooked” meals. We support this plan, but we also recognize that the Norwegian system mainly provides occasional access to comfort foods. We believe this system can be improved in order to provide daily access to healing foods.
In our version of this system, the Norwegian food outlet consists of two separate co-ops that operate out of the same location. These sister co-ops would be a classic "food co-op" that is operated on the consumers co-op model, as well as a culinary enterprise that would be organized on the worker-operated co-op model. Together they would make up Woodford Café.
The culinary co-op will operate a made-to-order meal service for San Quentin residents and staff, and manufacture packaged goods for sale to local markets and for donation to its sister co-op. The medical and cultural effect of the Café’s made-to-order service will be optimized by an intensive culinary training program. Graduation from this training program will be a prerequisite for anyone who wishes to join the culinary worker co-op, and it will prepare all graduates to compete in real world food services.
The culinary co-op will achieve financial self-sufficiency mainly through its manufacturing of goods for sale to the public, while preparing meals for San Quentin residents at the lowest possible rate. If the product lines produced by the culinary co-op become sufficiently successful, material contributions would also be made to the consumer co-op, similar to those which the agricultural co-op would make. When all co-ops work collectively to reduce the cost of healing foods for the entire population the modest stipend that would provide occasional comfort in the Norwegian system will become a more meaningful healing tool.
The consumer co-op will accommodate a diversity of food traditions by democratizing wholesale purchases of perishables, produce, and baking supplies; and by retailing goods at prices as close to wholesale as possible. This co-op will trade in whatever goods the voting members wish to trade in except for ultra-processed junk foods. The co-situation of the Café and grocery store will also embed decision architecture into the food environment that promotes healing ways of life. Our decision architecture will achieve this goal by serving an exclusively healing menu via the more conveniently accessed made-to-order food service.
If someone wants to make more traditional comfort foods, the system supports their interests, but they must purchase raw ingredients and take time out of their day to prepare their celebrated foods at self-cook stations. By making ingredients for all food traditions available, but healing foods markedly more convenient to access, food culture can be compassionately, but reliably, improved.
This is just one example of how the decision architecture that the food industry has long used to advantage over-consumption can instead be used to advantage healing – while still respecting all food cultures.
In all ways the decision architecture that new San Quentin food projects create (intentionally or unintentionally) should be scrutinized before those programs are implemented. In all cases, new programs should increase availability, accessibility, and utilization of foods that are, at the very least, not remarkably harmful to people and ecology. Ultra-processed junk foods are already so accessible to the incarcerated population that they are the standard currency of the informal markets that permeate the carceral setting. There is no need to make them more accessible.
A major point of interest in this regard, is where and how proposed food stipends are to be made redeemable. If no forethought is put into this, the overall effect of our food reform efforts could be a compounding of food desert harms. Or a transition from food desert to food swamp. Food swamps are areas were healthy food is available, but is inundated by unhealthy food. Food swamps are thought to be just as harmful, and much more prevalent, than food deserts.
Notably, we undertake this effort at a moment when the scientific community is telling us that changing our dietary practices is a non-negotiable part of surviving climate change; and at a moment when all our assumptions about humanity's inability to draw back from the metabolic abyss are being challenged by a humble corner of medical practice known as the Food-Is-Medicine movement.
In 2022 the White House issued the National Strategy on Hunger, Nutrition, and Health that underscored the importance of investing in Food-Is-Medicine (FIM) approaches.20 A growing body of evidence indicates these approaches are both clinically effective and cost effective,21,22,23 and are increasingly applied in mainstream medical spaces.24
At first glance FIM approaches appear unremarkable. These programs treat food-insecure people struggling with common metabolic illness – such as diabetes and heart disease – by issuing the same lifestyle prescriptions doctors drone on about every day of the week… eat fewer sugary foods, exercise more, etc., etc. These seemingly humble programs, however, appear to significantlyincrease adherence to standard lifestyle prescriptions… especially for low-income people. For this reason they may be nothing less than the Holy Grail of lifestyle medicine, and a turning point in the war against the plagues of modernity.
In FIM methodologies qualified medical professionals classify healthy food as a medicine; prescribe this “medicinal food” to food-insecure people who face illness that responds well to improved diet; and then use healthcare dollars to subsidize the cost of that medicinal food. Such Medicinal Food Assistance (MFA) is typically administered on the condition that patients participate in lifestyle education, peer-to-peer support groups, and other behavior modification programs. Health insurers are incentivized to cover the cost of MFA and associated services because these costs are often less expensive than the cost of the tests, treatments, and operations that would be necessary in the absence of FIM solutions.
Common examples of FIM systems include:
Food pharmacies that issue healthy food just as any pharmacy would issue medication
Medically Tailored Meals (MTM) that are customized to the patient’s personal medical needs
Grocery prescription programs that provide vouchers that are redeemable for healthy food at participating markets.
All of these systems are entering into a phase of clinical application and should be introduced where healing is needed most – in food deserts throughout rural and urban America, and in jails and prisons everywhere.
Clinicians describe FIM systems as breakthroughs that help “food-insecure” people combat “metabolic illness”. However, food insecurity and metabolic illness are concentrated in communities of color1 and kill thousands of people every day,25,26 so FIM systems would be better described as a powerful weapon in the fight against racial injustice. Approximately 7% of White adults in the US are diabetic, while for Black Americans the rate is 12%, and for Indigenous Americans and Pacific Islanders the rate 15%.27 On some reservations prevalence has run as high as 60%.28 This disproportionality is not the outcome of chance or character. It is the consequence of a system that regards food deserts as a basic human right and wellness as a privilege.
Overturning these injustices will require that we go beyond defending peoples’ right to standard pill-for-an-ill healthcare. We must defend all peoples’ right to heal and that will require that we heal the medical model itself. To do this, we must never pass up an opportunity to implement FIM approaches. And we must constantly improve the degree and scope of these systems’ impact.
A limitation of most FIM systems is that the savings they generate are either lost to the vagaries of public bookkeeping, snatched as profit by private insurers, or spent on exactly the kind of allopathic care that could be avoided if they were instead reinvested into further FIM approaches.
A fundamental tenant of the Right 2 Heal (R2H) design theory is that all savings generated by FIM systems should be tracked and reinvested into further instances of FIM. Moreover, interventional FIM systems should be used to generate budgets for preventive FIM systems, in order to impact food insecure people who are not yet sick – but are at elevated risk of becoming sick specifically due to food insecurity. If this kind of reinvestment scheme proves workable and is adopted widely, it could radically accelerate integration of the holistic model and the allopathic model – substantially impacting society and planetary ecology.
In the long run, this approach will push systems away from profit maximization and budget minimization. Nevertheless, discussing financial outcomes associated with early stages of the process can be helpful when seeking buy-in from various stakeholders. An exemplary Food Pharmacy operated by Geisinger Health, which focuses mostly on the treatment of food-insecure diabetics, estimates reductions in medical spending in the ballpark of $16,000 per patient per year; for an annual program operating cost of just $2,400 per patient per year.29
We propose that here at San Quentin a standard FIM food voucher system be coupled with a novel MFA delivery system – aka the Woodford Café. This system will strengthen adherence to lifestyle prescriptions by delivering MFA that is, when compared to other MFA, remarkably well prepared.
Regardless of the impact of this culinary MFA delivery system, any FIM program will render much greater per patient savings when operated in a carceral setting, because providing health care in prison involves hidden expenses and because in this setting some FIM operating costs can be externalized. The most outstanding hidden expense is the cost of sending security escorts with each and every patient transferred to an outside hospital. Transporting incarcerated patients to and from outside hospitals is a daily occurrence that balloons the cost of routine medical care. These costs are not accounted for as medical care however, in real terms, the state will be able to count the reduction of these costs as an outcome of FIM programs.
Here at San Quentin the cost of providing lifestyle education and peer-support components of FIM approaches would be externalized because San Quentin residents are already working to establish and operate these programs at no cost to the state. We are working with qualified experts to design a Brain Care course, and a peer-support group for people facing cardio metabolic conditions such as diabetes, heart disease, cancer, and eating disorders. These groups will be operated by mission-driven volunteers in collaboration with incarcerated co-facilitators.
We propose our MFA program be designed by an independent outfit, in partnership with departmental authorities, and that it be operated by San Quentin Medical. This program will involve simple screening criteria. To receive MFA, patients would have to be diagnosed with one of the cardiometabolic conditions that qualify for MFA treatment, and be willing to participate in lifestyle education courses. If a person meets these minimal criteria, they will be provided with a healing foods meal-credit account which renews its reserve of meal credits on a weekly basis. These credits will be redeemable only for healing foods prepared at the Woodford Café, and specific grocery items.
Our FIM system will be funded by the state, to begin with, but outcomes will be analyzed and estimated medical savings will be used to justify sustaining investments. If this program is found to be substantially cost effective, its benefits could be used as a basis to justify/ offset improvements in the quality of food served to all incarcerated people via prison chow halls.
Reasonably accurate tracking of outcomes associated with FIM programs is essential to the creation of an FIM system that leverages the benefits of interventional models for the purpose of funding preventive models. A number of different methods can be used to leverage medical savings for the purpose of increasing the state’s investment into food for all incarcerated people but all of these methods depend on good outcome tracking. For this reason we recommend the involvement of an independent research outfit, the development of research methodologies that are (at the very least) quasi experimental, and the pursuit of a substantial research grant.
Due to known difficulties related to prison Institutional Review Board (IRB) processes, it is also recommended that an expedited (but, by no means, less rigorous) IRB process should be created for outcome tracking associated with all aspects of the historic California Model. Due to the rapid schedule of its rollout, and the importance of proving these reforms do in fact reflect a new standard, we must be able to conduct science on the same timeline afforded to the rest of the scientific community.
To those who might be alarmed at calls for the research community to be given better access to a demographic that has historically been harmed by the research community, it should be emphasized that doing ground breaking FIM research in prison is actually a form of research reparations.
It would be painful if, after testing harmful and even deadly treatments on incarcerated people because they were voiceless, we then turned around and ignored those same voices when they called for research that is critical to the proliferation of healing systems within the carceral setting. It would be painful if we refused to subject this population to studies that deploy nothing but fresh fruits and vegetables, and mundane lifestyle recommendations that doctors already prescribe to residents of prisons everywhere. It would be painful if, out of our concern for incarcerated people’s well-being, we refrained from performing studies which investigate only the degree of healing achieved… the number of dollars saved… the number of marginalized people that could be prevented from dying on freedom's doorstep.
1. Felicia Hill-Briggs, et al. "Social determinants of health and diabetes: a scientific review". Diabetes Care. January 2021.
2. Andrew P. Wilper, et al. "The health and health care of US prisoners: a nationwide survey". American Journal of Public Health. April 2009.
3. Fernando de Oliveira Meller, et al. "The influence of diet quality on depression among adults and elderly: a population based study". Journal of Affective Disorders. March 2021.
4. Joseph Firth, et al. "Food and mood: how do diet and nutrition affect mental wellbeing?". The BMJ. June 2020.
5. Penny M. Kris-Etherton, et al. "Nutrition and behavioral health disorders: depression and anxiety". Oxford Academy - Nutrition Reviews. May 2020.
6. Maurizio Muscaritoli, et al. "The impact of nutrients on mental health and wellbeing: insights from the literature". Frontiers in Nutrition. March 2021.
7. Mateusz Grajek, et al. "Nutrition and mental health: a review of current knowledge about the impact of diet on mental health". Frontiers in Nutrition. August 2022.
8. Donna Jackson-Nakazawa. The Angel and the Assassin: The Tiny Brian Cell that Changed the Course of Medicine
9. Janelle Orsi and Emily Doskow. The Sharing Solution: How to Save Money, Simplify Your Life, and Build Community. May 2009.
10. Andrea Perrone, et al. "Working and forgiveness behind bars: Giotto in the Due Palazzi Prison of Padua". Working Paper, Percorsci di Secondo Welfare, Torino, Italy. March 2015.
11. Meegan Moriarty. "From bars to freedom: Prisoner co-ops boost employment, self esteem, and support re-entry into society". Rural Cooperatives 83, No 1 January/February 2016. pp. 14-18, 37.
12. From a report prepared by the International Labor Organization (Country Office for Ethiopia and Somalia) and the Italian Development Corporation. “The Mekelle Prison Project: Creating sustainable livelihood opportunities for women and youth.” ND.
13. Jessica Gordon Nembhard. "How prisoner co-ops reduce recidivism: lessons from Puerto Rico and beyond". NPQ – Nonprofit Quarterly.org. May 2020.
14. Darrah Perryman. "National Co-op Month: How USDA Rural Development Supports Cooperatives". Posted in USDA Rural Development. October 2022.
15. Geoff De Ruiter. “Are Co-operatives the future of business?” EarthEasy.com. July 2012.
16. Hillary Abell, et al. "California Cooperatives: Today's landscape of worker, housing and childcare cooperatives". Project Equity, the California Center for Cooperative Development, and the Sustainable Economies Law Center. 2021.
17. George Lakey. Viking Economics: How the Scandinavians Got It Right-and How We Can, Too. 2016. p 96.
18. Posted: BeeInformed.org. “Preliminary results: 2017-2018 total and average honey bee colony collapse by state and the District of Columbia”. June 2018.
19. Donald W Roberts and Raymond J St. Leger. “Metarhizium spp. Cosmopolitan Insect-Pathogenic Fungi: Mycological Aspects”. Advances in Applied Microbiology. V54, February 2004. p 1-70.
20. The White House. National Strategy on Hunger, Nutrition, and Health. September 2022.
21. Editorial. "Food as Medicine: translating the evidence". Nature Medicine. V29, April 2023.
22. Thiago Veiga Jardim, et al. "Cardiometabolic disease costs associated with suboptimal diet in the United States: A cost analysis based on a microsimulation model". PLOS Medicine. December 2019.
23. Hannah Martin, et al. "Advocating for expanded access to medical nutrition therapy in Medicare". Journal of the Academy of Nutrition and Dietetics. April 2021.
24. Rya Jetha. "Just what the doctor ordered: in California, a prescription could pay for your fresh fruits and veggies". CalMatters. August 2023.
25. Wenya Yang, et al. "Economic costs of diabetes in the US in 2017". American Diabetes Association – Diabetes Care. May 2018.
26. American Heart Association. 2022 Heart Disease and Stroke Statistics Update Fact Sheet At-a-Glance. 2022.
27. Centers for Disease Control and Prevention. CDC National Diabetes Statistics Report (2022). (Latest figures compare 2014-2019) 2022.
28. NICOA (National Indian Council on Aging). https://nicoa.org/diabetes-still-highest-among-ai-an/states. January 2019.
29. Andrea T. Feinberg, et al. "Integrating mental, social, and physical health: prescribing food as a specialty medicine". Geisinger Health Systems. April 2018.