Health Bucks

New York City Department of Health and Mental Hygiene (DOHMH)

Overview

Health Bucks is a PSE change intervention designed to distribute $2 coupons that can be used to purchase fresh fruits and vegetables at participating farmers’ markets. By providing a financial incentive that increases purchasing power, the Health Bucks program helps residents of low-income neighborhoods increase their consumption of fresh fruits and vegetables. Additionally, by making it financially possible for local farmers to participate in markets in areas that historically have been less profitable, the Health Bucks program affects the physical environment of low-income neighborhoods by increasing access to and availability of fresh produce. Health Bucks affects a neighborhood’s social environment by encouraging low-income customers and Supplemental Assistance Nutrition Program (SNAP) participants to shop at local farmers’ markets.

Target Behavior: Healthy Eating

Intervention Type: PSE Change

Intervention Reach and Adoption

Health Bucks offer a financial incentive for residents of low-income neighborhoods to purchase fruits and vegetables at farmers’ markets. The program makes a concerted effort to get Health Bucks into the hands of low-income people by distributing them through community-based organizations and at farmers’ markets operating in underserved areas. Health Bucks customers often receive USDA nutrition benefits, such as SNAP, Farmers’ Market Nutrition Program coupons for low-income women, infants and children (WIC FMNP) and the FMN program for low-income seniors. All farmers’ markets that accept SNAP through EBT give one Health Buck coupon to each customer for every $5 spent using SNAP.

Setting: Community, Retail

Target Audience: Preschool (<5 years old), Elementary School, Middle School, High School, Pregnant/Breastfeeding Women, Parents/Mothers/Fathers, Adults , Older Adults

Race/Ethnicity: All

Intervention Components

In 2005, the Health Bucks program was developed by the New York City Department of Health and Mental Hygiene. A combination of NYC agencies funds the Health Bucks program. The District Public Health Offices (DPHOs, satellite public health offices in the three highest need areas of the city) distribute Health Bucks to community organizations and farmers’ markets in surrounding low-income neighborhoods. Community organizations can apply to receive Health Bucks for distribution to their clients as an incentive to support nutrition education and other health promotion activities and to encourage first-time shoppers to visit neighborhood markets. Market managers at participating farmers’ markets who operate the Electronic Benefit Transfer (EBT) terminals distribute Health Bucks to SNAP (food stamp) users as an incentive for them to purchase additional fresh produce. At these markets, SNAP consumers receive a $2 Health Buck for every $5 in EBT spent at the farmers’ market — effectively a 40% increase in purchasing power.

To view intervention materials used in the New York City Health Bucks program, visit the program’s website: www.nyc.gov/health/farmersmarkets

Available online are:

  • Marketing posters and flyers
  • Map and listing of participating farmers’ markets
  • Community-Based Organization Application for organizations requesting to distribute Health Bucks
  • Reports detailing history of Health Bucks program

Intervention Materials

To view intervention materials used in the New York City Health Bucks program, visit the program’s website: www.nyc.gov/health/farmersmarkets

Available online are:

  • Marketing posters and flyers
  • Map and listing of participating farmers’ markets
  • Community-Based Organization Application for organizations requesting to distribute Health Bucks
  • Reports detailing history of Health Bucks program

Evidence Summary

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.

Classification: Practice-tested

Evaluation Indicators

Based on the SNAP-Ed Evaluation Framework, the following outcome indicators can be used to evaluate intervention progress and success.

Short Term (ST) Medium Term (MT) Long Term (LT) Population Results (R)
Individual MT1
Environmental Settings MT5 LT5
Sectors of Influence

Evaluation Materials

The Health Bucks Evaluation Toolkit was created to assist farmers’ market incentive programs to design and implement evaluations. The tools provided in the kit can be adapted for incentive programs of various sizes, and can be scaled to guide both small and large evaluations depending on available resources. The toolkit uses the New York City Health Bucks program as an example, providing evaluation tools, sample evaluation questions and recommendations/lessons learned. This toolkit was developed by Abt Associates Inc., with the Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity (CDC DNPAO) and the New York City.

Additional Information

Website: The Health Bucks website (http://www1.nyc.gov/site/doh/health/health-topics/health-bucks.page) includes information on how to get Health Bucks, program news, and other resources.

Contact Person:
NYC Dept. of Health and Mental Hygiene
Email: farmersmarkets@health.nyc.gov