At this moment in eastern Kentucky, many counties and communities are grappling with how to replace the revenue that the coal industry funneled into the area for decades.
In Letcher County, people are struggling with higher than average rates of diabetes and other diet-related illnesses, and they have lower than average household budgets with which to buy food. Across the county, 55 percent of adults have been diagnosed with high blood pressure or hypertension, and nearly a third of families live below the poverty line.
Despite being an area rich in agricultural knowledge, Letcher County is ranked nearly the lowest in Kentucky for overall health factors and outcomes, including access to fresh fruits and vegetables, and resources are scarce to help feed young people and seniors. The local meal program for seniors has been cut back so far that for years meals have been mailed to seniors from the closest well-funded hub -- in Iowa.
A new partnership between Mountain Comprehensive Health Corp., a local hospital, and the Community Farm Alliance, a grassroots organization that supports independent farmers, is helping remedy that. Community Agricultural Nutrition Enterprises is a project that supports the livelihoods of local farmers, increases access to fresh healthy food, and improves health outcomes for Letcher and surrounding counties.
The intent is for CANE to become a full-fledged community hub for nutrition, health, and wellness, with a community kitchen, preschool day care, and medical providers all under one roof -- and it's already well on its way.
It began on a fall Saturday morning in 2014 at the farmers market in Whitesburg, Kentucky, when Valerie Horn saw a young boy walking alone on a nearby track. Horn, the Healthy Communities Initiative director for the Community Farm Alliance, reached for one of the healthy breakfasts that she had been giving away as part of a summer feeding program. But the food was gone because school was in session again and her grant had run out. Horn looked at the boy once more, and saw he was too uncomfortable to come into the farmers market. "I remember asking myself, Who is this market for?" Horn recalls. "And I thought, It's for him."
"Hey," Horn called out to the boy, who she knew from around the community. "Come get a free smoothie, come get a free breakfast wrap!" The boy came and Horn scrounged up the ingredients and space in one of the vendor's tents to prepare it.
The week after that encounter, Horn and some colleagues went to the grocery store and bought items to combine with locally grown produce to provide market visitors with a free, healthful breakfast. People loved the food, and the farmers loved that their produce was bought in bulk to make the meals. Then one day, Mike Caudil, CEO of Mountain Comprehensive Health Corp., a nonprofit rural community health center that provides care to more than 30,000 people in eastern Kentucky, came to the market and saw what Horn and her helpers were doing. He told her, "I think our board can pay for what's happening here," Horn says.
"Farmers markets have the reputation of being somewhat elitist, not open to all," she says. "That is the opposite of here. The intent was not to be a poor person's market, but to be a market for everyone. There are folks with money who come, but our market board has said if rich folks want this to be an experience for them, they may have to go somewhere else for that."
The Letcher County Farmers Market also prepares food on-site that it gives to kids under 18 for free and at a discount to adults. CANE has built upon the market's existing infrastructure and programming to keep expanding access to fresh food. Already in place was a program called the Farmacy Program, which grants to patients with diet-related diseases free produce from the farmers market.
The Farmacy program has so far given 200 patients "prescriptions" that they can exchange for wooden tokens to buy produce at the market.
"A doctor tells someone, 'You need to start eating more greens,' but they say, 'Well, I only get $122 a month in SNAP, I just can't afford that stuff,'" Horn says. With the doctor's prescription, now they can.
Barry Linville, a Letcher resident who is diabetic, wrote a letter to Horn thanking her for changing his life for the better. His blood sugar reading was 14 millimoles per liter in February 2016, but had fallen to 6 by that October. "I credit the market for bringing it down," he wrote. "That's the difference between living and dying."
From 2013 to 2016, the program has helped raise farmers market revenues from $6,000 to $120,000, and it's lent assistance to other area markets to set up their own Farmacy programs.
The vegetable prescription program is funded through local partners that include MCHC, the University of Kentucky, Wellcare Insurance, and Lab Corp., plus a federal Food Insecurity Nutrition Incentive grant. It also is a model that is taking off all over the country, in use by many community nutrition programs like Connecticut's Wholesome Wave. Horn learned about that program through her work and then adapted it for use in Whitesburg in 2015. Since then, the prescription program has expanded to six locations in eastern Kentucky, though the one in the county seat gets the most use.
Horn and her colleagues chose the veggie prescription model for a specific reason, she says. "There are many programs that try to give poor people access to cheap produce, but it's done on the backs of the farmers by asking growers to sell their product at reduced prices," she says. "We knew we didn't want to do that."
The structure of the Farmacy program means a lot more money is going into the pockets of growers, and the program's subsidies allow a lot more people to afford fresh produce. On one recent Saturday, 133 families spent $3,500 at the farmers market through the prescription program, Horn says.
The next step for CANE is creating a nutrition and health hub. In June 2015, MCHC bought a former high school building in Whitesburg and began leasing it to CANE for one dollar per year. The 9,000 square-foot facility has a large commercial kitchen, and CANE is renovating it with $150,000 in funding from Grow Appalachia, MCHC, Appalshop, and the Brooke T. Smith Foundation, and matched by an equal amount from the Governor's Office of Agricultural Policy. CANE hopes open the hub in 2018 and offer a wide array of community programs and services, including letting growers use the kitchen to preserve their produce and make other food products derived from them, such as apple butter.
CANE plans to offer classes for people who may not be used to cooking with raw produce, and partner with the farmers market on a larger scale to buy produce for its summer feeding program for those without good access to fresh fruit and vegetables. Horn sees it as a win-win: each Saturday when the market is over, CANE would buy the excess so farmers know that whatever they bring to the market will be sold. The meals prepared at the community kitchen would go back into the community at no cost.
"I'd like to see people, instead of going to Wendy's at the end of the day, people can go up there and get a healthy and happy meal," Horn says.
Whitesburg also lacks open community space, so the CANE building would become a free and safe event space for other community groups. As new people become aware of the building's offerings, Horn hopes more new people will become channeled toward healthy food.
On top of grant money, CANE plans to seek a contract with Letcher County to provide meals to the local jail, which would provide a steady source of revenue.
Whitesburg and surrounding communities of eastern Kentucky are excited about what CANE will offer and already are responding to programs as they are rolled out. On July 22, CANE posted on Facebook that they would be holding a canning class at the Cowen Community Center; three days later, more than 100 people came.
Horn says she thinks of CANE as a "four-legged tent," the kind of pole-supported canopy commonly used by vendors at farmers markets.
"One leg is those growers being able to sell and make as much income as they can," she says. "The second leg is about [making] sure everyone in the community has as much access to those vegetables as anyone else, particularly the vulnerable populations."
The third support is connecting with and encouraging people to come, such as an incentive that gives Farmacy and other customers additional currency to spend at the market if they walk there. The farmers market also takes SNAP, WIC, and Senior Dollars.
The fourth leg or support is the money coming in. "We are trying to pull the community's dollars back into the market, which puts them back into the ground," Horn says.
It all makes for a virtuous cycle that keeps the economy stable and improves the health and livelihood for local people.
"I'm still in awe when I see all the folks on Saturday mornings lining up to get into the market. I can really see that it matters to them," she says.
This story was funded in part by a grant from the One Foundation.