N° 96 | January 2015

Extending Cancer Prevention by Improving Fruit and Vegetable Consumption

Nutrition and Health

Consuming vegetables and fruits (V&F) is associated with decreased risk for chronic diseases, including cancers. Despite the clear health benefi ts, few Americans consume the recommended daily servings of V&F1. Clearly, more attention should be directed at food systems change. In contrast to focusing on individual behaviors, food systems interventions address broader issues infl uencing V&F intake. The hallmark of these interventions is an implicit belief in the connection between agriculture, community health activism, and public health programming–sectors that have limited experience working together, especially in intervention implementation.

Leveraging Existing Resources

One strategy to increase V&F intake involves leveraging the triad of Cooperative Extension Services (CES), public health systems (PHS), and community health centers (CHC). Through a mutual interest in promoting health equity and community and economic vitality, this collaboration provides common ground to spread evidence-based food systems interventions and share resources to foster grassroots support to sustain change.

PHS’ long-standing work on policy, systems, and environmental change has been credited with promoting dramatic improvements in human health over the past century. CES also have a century of experience in bridging the gap between research and practice. Today, CES have “boots on the ground” connected to 100+ colleges and universities. CHC are key linkages for connecting CES and PHS. Formed in the 1960s, CHC provide patient-centered care to medically underserved populations regardless of income. Today ≥7,500 CHC in the U.S. are committed to community and economic development as a part of a health care mission.

Connecting the Triad to Improve V&F Consumption

The Right Choice Fresh Start (RCFS) farmers’ market represents a partnership of the three entities implementing a food systems approach to improve V&F consumption2. The goal of the RCFS was to examine the feasibility of establishing a farmers’ market at a CHC. CES was central to the formation of the RCFS farmers’ market by identifying farmers who informed the development of the market and served as vendors, providing technical assistance regarding farmers’ market operations, serving on the RCFS Advisory Council.

Exchanges between CES, CHC, and PHS occurred in mutually benefi cial ways. Researchers gave public talks at RCFS celebrations about the benefi ts of V&F consumption and cancer prevention. This information guided educational services offered by CES. The CHC created a “farmers’ market produce prescription” to incentivize V&F purchases made by patients completing diabetes education and to boost revenue opportunities for farmers. The state PHS later supported the RCFS through a grant to fund the farmers’ market manager and created a healthy food incentive program. CES offered additional support to the RCFS manager through engagement in monthly farmers’ association meetings that introduced the manager to additional farmer-vendors and provided critical insights into some of the opportunities and challenges associated with growing V&Fs. Finally, this partnership helped the RCFS garner more resources to provide healthy foods to CHC patients and enhance economic opportunities for smallscale farmers.


The RCFS exemplar highlights synergies among PHS, CHC, and CES to enhance community, economic, and health development. Each entity has a tradition of applying expertise to these goals, though none has the capacity to single-handedly change the food system for public health benefit. Working together, the triad has the opportunity to build on their respective strengths, creating a culture for co-learning, capacity building, and other mutual benefits while helping to decrease cancer risk across the broader population.

  1. Norat T et al. Fruits and vegetables: updating the epidemiologic evidence for the WCRF/AICR
    lifestyle recommendations for cancer prevention. Cancer Treat Res 2014; 159:35-50.
  2. Freedman DA et al. Extending Cancer Prevention to Improve Fruit and Vegetable Consumption. J
    Cancer Educ 2014; 29(4):790-5.
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