Health Bucks

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

Overview

The Health Bucks program is a PSE change intervention that distributes $2 coupons redeemable for fresh locally grown fruits and vegetables at New York City (NYC) farmers markets. Health Bucks increase purchasing power and help New Yorkers with low incomes access fresh fruits and vegetables. Health Bucks are distributed several ways, including to customers at farmers markets paying with Supplemental Nutrition Assistance Program (SNAP) benefits. The Health Bucks SNAP incentive increases markets’ SNAP sales and makes markets more profitable(1). This makes it financially possible for local farmers to participate in markets in areas that historically have been less profitable and affects the physical environment by increasing access to and availability of fresh produce. Health Bucks affects a neighborhood’s social environment by incentivizing to shop at local farmers markets.

Target Behavior: Healthy Eating

Intervention Type: PSE Change

Intervention Reach and Adoption

Health Bucks are nutrition incentives that help make fruits and vegetables sold at farmers markets more affordable. Health Bucks are distributed at farmers markets to customers using SNAP benefits and through communitybased -based organizations serving New Yorkers with low incomes. Customers using Health Bucks often receive USDA nutrition benefits, such as SNAP, Farmers’ Market Nutrition Program (FMNP) coupons for women, infants and children (WIC FMNP) and seniors (SFMNP). From 2007-2020, farmers markets distributed $2 in Health Bucks for every $5 spent using SNAP benefits. Beginning in 2021, farmers markets distributed $2 in Health Bucks for every $2 spent in SNAP benefits, up to $10 in Health Bucks per day. In 2016, the Health Bucks SNAP incentive was extended from 5 months to year-round.  

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 (Health Department). The program is funded by the NYC Health Department and USDA Food Insecurity Nutrition Incentive Program and Gus Schumacher Nutrition Incentive Program grants. With support from staff in the Health Department’s, satellite public health offices that aim to improve health in neighborhoods with disproportionate burdens of premature mortality, Health Bucks are distributed to  community-based organizations and farmers markets. Community-based 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. Farmers market managers distribute Health Bucks to customers paying with SNAP benefits. At these markets, customers get $2 in Health Buck for every $2 spent in SNAP benefits up to $10 in Health Bucks per day — effectively a 100% increase in purchasing power. 

Intervention Materials

To view intervention materials used in the New York City Health Bucks program, visit the program’s website: https://www1.nyc.gov/site/doh/health/health-topics/health-bucks.page

Available online are:

  • NYC farmers market map 
  • Health Bucks toolkit with resources for community-based organizations 
  • Application for free Health Bucks for community-based organizations (available seasonally) 

Intervention Costs

Materials available at no cost.

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, surveys of individuals who used Health Bucks demonstrated that Health Bucks were associated with more frequent farmers market visits and spending more at farmers markets overall (2). The program also addresses multiple evidence-based strategies to reduce diet-related chronic diseases. 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

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. Please reach out to the primary contact listed below for access to these evaluation materials.

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:

Nicole Andersen – Senior Manager, Nutrition Incentives

NYC Dept. of Health and Mental Hygiene

Phone: 347-396-4330

Email: farmersmarkets@health.nyc.gov