Data Note
April 2025
Marsha Regenstein, Feygele Jacobs, Leticia Nketiah
Community health centers, which celebrate their 60th anniversary in 2025, offer comprehensive primary care and preventive health services to 31.5 million people across more than 15,500 service sites. They are located in medically underserved areas, where essential health care is often in very short supply. Health centers serve as important health hubs, where clinical services are provided alongside programs focusing on nutrition and community health and wellness. This overview highlights health centers’ efforts to address food insecurity and support access to healthy foods and wellness programs for people with chronic conditions such as diabetes and obesity.
Health centers have focused since their inception on tackling malnutrition
At the core of the community health center model is the concept of community-oriented primary care (COPC), which emphasizes the health of a defined community or population. The COPC framework envisioned health care as a broad set of services that were designed to prevent and treat illness and maintain health at both the individual and broader population level. Dr. Jack Geiger, a pioneer in the establishment and growth of health centers in the U.S., co-founded the first rural health center in a small Mississippi community plagued by poverty, widespread malnutrition, stunted growth, greater disease burden, and other consequences of deprivation and nutritional deficiencies. Dr. Geiger began writing prescriptions for food as a targeted therapeutic response to malnutrition, asserting famously that “Last time I looked it up in my medical books, the treatment for malnutrition is food.” Alongside the prescriptions, a farm co-op established by the health center provided access to nutritious food that had previously been out of reach.
Building on this early intervention, health centers have continued to integrate direct clinical services with healthy eating and access to nutritious foods through a multitude of creative programs at clinic sites and other community-based locations. CHCs address nutrition through multiple strategies. Beginning with pregnant women and young children, many health centers have on-site WIC offices that provide access to free and nutritious foods, nutrition education, and breastfeeding supports, among other services. Other initiatives include individual and community-based prevention-oriented health education; partnerships with local grocers, farmers markets, and other outlets for fresh fruits and vegetables; chronic disease management programs for diabetes, cardiovascular care, high blood pressure, cancer, and other conditions that are closely associated with diet; and participation in research studies to develop and test interventions that may be particularly beneficial to health center patients.
Health centers help bring nutritious foods to their patients and communities
Many health centers have implemented programs to facilitate access to healthy foods. For example, health centers in Vermont and New Hampshire work with local groups to increase access to fresh fruits and vegetables in their “Food as Medicine” program, which includes nutrition education, with a strong focus on people with chronic conditions. In East Boston, Massachusetts, NeighborHealth is part of a local Community Supported Agriculture (CSA) program that allows community members to buy shares in local farms and in this way benefit from their harvests. For more than a decade, NeighborHealth has been partnering with a local farm, providing discounted rates for community members who are interested in buying fresh fruits, vegetables, and other locally grown products. Hawaii’s Waianae Coast Comprehensive Health Center operates three Makeke farmers markets, which offer local West Oahu residents a chance to purchase lower-cost fresh fruits and vegetables, while also supporting local small farmers. Makeke is the Hawaiian word for market.
CHC “Food as medicine” strategies include effective nutrition "prescription programs” and other supports
Food prescription programs “prescribe” healthy foods, access to food and nutrition programs, and enhanced access to fresh fruits and vegetables to their patients and other community members. Some of these programs target people with diabetes, obesity, or other conditions where healthier eating and better access to healthy foods would have enormous personal health benefits while potentially delivering savings to the health system. These types of prescription programs have been implemented in health centers in both rural and urban areas, and in all regions of the country.
Health centers in rural Idaho and Oregon, for example, ran a fruit and vegetable prescription program (“FVRx”) as part of an effort to improve diabetes control among rural residents with economic and social barriers to care. The program helped reduce very high blood glucose levels. A food prescription (“Food Rx”) program in Texas health centers saw marked decreases in nutrition insecurity and consumption of 99 percent of the fruits and vegetables provided to participating families. In this case, families received and consumed about 29 pounds of fruits and vegetables each month while participating in the program.
To improve health for people with chronic conditions, six Chicago health centers participated in a Food Rx program in collaboration with Walgreens and a local farmers market, both of which provided healthy food options specific to the needs of participating health center patients. The prescription program encouraged behavior change among health center patients with diabetes, provided nutrition education, and linked patients to community resources, which resulted in culture change not only among health center patients but also among the participating partners.
A pilot program in Michigan used a similar approach, specifically targeting low-income patients with uncontrolled diabetes. The health center ran a farmers market at the clinic site, with patients randomized to a control group that received information on community resources to improve health, and other patients randomized to receive a monthly stipend to purchase fruits and vegetables at the farmers market. Those who received stipends had significantly lowered hemoglobin A1c tests compared to the control group, indicating that their diabetes was better managed. Likewise, a health center in rural South Carolina that implemented a farmers market and financial incentive intervention also found that the program increased daily intake of fruits and vegetables among low-income diabetic patients. A health center in Franklin County, Massachusetts, provided cash incentives for patients to purchase membership in a local community farm during a 6-month growing season. Participants achieved significantly improved diet quality, by consuming more vegetables, fruits, and whole grains. In each of these programs, health centers played a key role in addressing both food insecurity, which can increase the risk of being overweight and is associated with a much higher risk of diabetes, and access to foods that are especially nutritious for diabetic and pre-diabetic patients.
Health centers promote wellness through onsite and community-based programs
In addition to offering food and nutrition-focused programs, many health centers provide service enhancements, especially for patients with chronic health conditions, aimed at promoting healthy lifestyles and emphasizing physical activity, weight loss, wellness counseling, and culturally and budget-oriented nutritious cooking. For example, a large health center with an on-site wellness center created an exercise “prescription” program much like the food and nutrition programs that have been so successful. The exercise prescription referred patients to the on-site exercise facility as well as to a personal fitness advisor. About half of the people referred to the wellness center took advantage of the exercise program. Patients who were older and less physically active reported the highest gains in physical activity. Some health centers have also offered no-cost membership to local YMCAs to encourage weight loss and physical activity.
Health center programs to encourage physical activity and address obesity take many forms, but many include counseling sessions to encourage lifestyle changes, group exercise classes or walks including popular “walk with the Doc” programs, home visits to help with healthy cooking and food choices, and interactions with community health workers or other support systems. Some health centers have offered obesity management visits through school-based health centers to address overweight and obesity in children and adolescents. A study of one such program found significant decreases in consumption of sugary drinks and more days exercising.
Health centers are leaders in integrating community health workers to improve and maintain health
Community health workers (CHWs) have been successful in improving chronic disease management, especially in under-resourced communities. More than a quarter of health centers employ community health workers as outreach workers, patient navigators, or community health representatives. Often, community health workers are part of the healthy nutrition initiatives that encourage patients to improve their diets or to make and maintain lifestyle changes that can help them better manage diabetes, obesity, heart disease, and other chronic conditions. CHWs come from the same communities as their patients and are highly skilled in understanding the everyday challenges that people in the community face to maintain health. For example, in 2019, Mariposa Community Health Center in Arizona developed a program called “Comer Bien (Eat Well)” that helped patients with diabetes better control their blood sugar levels. Mariposa CHWs offered classes to patients and conducted home visits, provided care management, and offered cooking and exercise tips to make healthy cooking and healthy eating more accessible. CHWs were instrumental in identifying a key barrier to healthy eating: patients did not have a reliable source of transportation to get to grocery stores to access fruits, vegetables, and other healthy food options. CHWs were able to refer patients to local resources to facilitate access to groceries and other local services. Nationally, health center CHWs are instrumental to many other types of initiatives to improve community health and facilitate access to health services related to childhood asthma, maternal and child health, healthy aging, and other areas.
Health Centers Support Whole-Person Care
Health centers have long recognized the importance of ensuring that communities across the country have access to high-quality primary care and preventive services, as well as other supports necessary to lead healthy lives. The examples above offer just a few illustrations of how health centers integrate health and wellness alongside their clinical offerings, address food insecurity in children and families, and help to prevent and treat chronic conditions such as diabetes, obesity, and heart conditions.
Health centers continue to explore ways to help their patients and communities achieve healthy lives. In 2024, the National Association of Community Health Centers (NACHC) partnered with Abbott to sponsor an “Innovation Incubator” to address food insecurity. Eight health centers were part of an inaugural group working on projects to create community gardens, conduct nutrition education that addresses literacy and digital challenges, and provided people including expectant mothers and those with chronic diseases with customized nutrition, among other projects. The Abbott-NACHC partnership provided grants and expertise to help CHCs design, implement, and describe the results of their projects, which are being shared with health centers nationwide. Asian Health Services’ (Oakland, CA) "Happy Kitchen," prize-winning program engaged the community about nutritious food and healthful cooking through cooking courses in Chinese and Vietnamese, while Tri-Area Community Health (Laurel Fork, VA) developed an AI-powered tailored nutrition education app. Many other initiatives are also taking place through state primary care associations that share innovative and successful food and nutrition models with other organizations in their states and in neighboring states.
Health Centers Need Adequate and Stable Funding
Health centers are innovative organizations that provide outstanding primary care, prevention, and health promotion services to their patients and communities. CHCs also recognize the critical need for adequate food and nutrition for their patients – at all stages of their lives – and have incorporated programs to address their nutritional needs. Medicaid covers more than half of all health center patients and is the most important revenue source. Federal grants make up a smaller portion of health center revenues but provide the means by which health centers care for uninsured patients and provide crucial services that many insurers do not cover. Maintaining these important sources of funding is essential for the millions of families and communities who depend on community health centers.