Evolving food as medicine programs to advance health equity: insights from two decades of practice

The Food as Medicine (FAM) movement has gained momentum as a strategy to address food insecurity and manage diet-related chronic conditions by integrating food prescriptions, medically tailored meals, and culinary and nutrition education into clinical care. However, few FAM programs have evaluated long-term sustainability, equity outcomes, or structural impact on systems-level change beyond food insecurity in the hospital setting alone. This case study reviews feasible, equity-centered evaluation strategies leveraged by the Nourishing Our Community Program (NoC) at Boston Medical Center (BMC), one of the country's oldest and most comprehensive health system-based FAM initiatives.

We trace the historical development of NoC, highlighting key adaptations in evaluation strategy and outlining embedded data collection methods across clinical and community settings. The evaluation approach captures both traditional metrics (e.g., food insecurity screening outcomes) and broader measures, including patient experience, cultural relevance, and local economic impact.

By embedding equity into every stage of program design and assessment, this case study provides a replicable framework for health systems aiming to sustain and scale food-based interventions. It also contributes to the limited but growing body of literature on systems-level implementation of FAM programs that address both individual health outcomes and structural drivers of inequity.