Potential Public Health Impact
The Health Bucks intervention has a high potential for public health impact.
Reach: The potential for reach is high due to the different opportunities/avenues for distribution/redemption of coupons in low-income and poor access areas. The program is intended for SNAP participants and residents of low-income neighborhoods and aims to engage community-based organizations (CBOs) that work with such populations. Additionally, community engagement with intended populations is a key program component that increases its potential for reach.
Effectiveness: While the evidence of the Health Bucks program’s direct impact on behavior (increasing consumption of fruits and vegetables) is limited, perceived and actual benefits appear to be strong. The Health Bucks program demonstrated increased access to locally grown fresh produce by expanding the number of farmers /vendors willing to operate in low-income neighborhoods. Additionally, Health Bucks demonstrated an increase in the purchase of fresh fruits and vegetables as reflected by annual increases in coupon redemption. The program also addresses multiple evidence-based strategies to reduce obesity. CBOs often combine Health Bucks with other health promotion activities (e.g., nutrition education, one-on-one counseling), which enhances the program’s potential impact. Many CBOs reported adding or expanding nutrition programming as a result of distributing Health Bucks.
Adoption: The Health Bucks program and similar programs have been adopted by various farmers’ markets across New York City and in similar cities with comparable infrastructure and “buy-in” from the community. Adoption may be limited in rural areas and towns without the financial resources and community infrastructure needed to support the intervention.
Implementation: Various key stakeholders (e.g., market vendors, community-based organizations and coupon recipients) have responded positively to the program. Overall, they have felt the Health Bucks program has been fairly easy to implement. Also, the reimbursement/redemption of coupons has been acceptable to participating farmers. Technical assistance (toolkits and trainings) are offered to participating markets and community organizations. Successful program implementation depends on the involvement of state, local and community partners.
Maintenance: The current program has been in existence for seven years. Staff and skill capacity necessary to sustain such a program should be available in most locations, however, the cost of maintaining the fiscal capacity for the incentive program is a concern for sustainability.