Feasibility of Operating a FQHC-Based Farmers' Market in a Rural Context

Purpose: Obesity rates are highest among minorities in the Southern region of the U.S. (Pan et al., 2009), populations that are more likely to live in communities defined as “food deserts” (USDA, 2009).  Food deserts are associated with decreased access to a wide variety of affordable foods needed for a healthy diet (USDA, 2009). Farmers’ markets have been identified as strategic approaches for curtailing obesity trends (CDC, 2009); yet, few markets are designed to serve disparate populations. In 2009, only 18% of all farmers’ markets were authorized to accept food subsidies through electronic benefit transfers (USDA, 2010).  The purpose of this presentation is to describe the formation of a federally qualified health center (FQHC) based farmers’ market and highlight sales trends during the first market season.

Methods: A community-based participatory research (CBPR) approach was used to form the first FQHC-based farmers’ market in South Carolina. FQHCs are community health centers that provide comprehensive primary care to medically underserved populations. The market opened in a rural county that has a majority African American (63%) population. The CBPR process began with a community readiness assessment to select the site, a community visioning meeting with 49 stakeholders, and the formation of a 9-member community advisory board. Twenty-two farmers’ markets operated in 2011. Sales transactions at the markets were documented through a standard receipt system. Structured observations at the market were used to assess socio-demographic characteristics of customers.

Results: Most of the farmers’ market customers were African American females. A total of 3,681 sales transactions occurred at the markets (average, 158/week; range, 66-296). Almost half of market sales involved transactions with patients (27%) or staff (21%) from the FQHC with the remaining made by community members. Total revenue from the market was $14,554, which went to 9 small-scale rural farmer vendors. Most sales were paid in cash (63%); payment with food subsidies was the second most common payment method (18%).

Conclusions and Implications: Results provide a model for engaging stakeholders in the formation of a farmers’ market in a food desert. Data suggest that it is feasible to operate a farmers’ market in conjunction with a rural FQHC. The market provided improved access to produce for patients and staff at the health center as well as the community-at-large; it also provided economic opportunity for small-scale rural farmers. Future research is needed to develop targeted approaches to increase food subsidy usage at the market and to understand the influence of the market on dietary patterns related to obesity trends.

USDA. (2009). Access to affordable and nutritious food: measuring and understanding food deserts and their consequences. Washington, DC: Economic Research Service.

USDA. (2010). Feasibility of implementing electronic benefit transfer systems in farmers' markets: Report to Congress. Washington, DC: U.S. Department of Agriculture.

CDC. (2009). State indicator report on fruits and vegetables, 2009. Atlanta, GA.

Pan, L., et al. (2009). Differences in prevalence of obesity among black, white, and Hispanic adults -- United States, 2006--2008. MMWR, 58(27), 740-744.