(Click here to view a companion photo essay)

A silver-haired poet fingers red and yellow heirloom tomatoes. A young woman asks a farmer if she can substitute Asian pears in her applesauce recipe. A plump toddler in a double stroller reaches for a bundle of grapes dangling just out of reach. A typical scene at a California farmers market. What’s atypical is that this organic market blooms on a dull apron of concrete in front of Kaiser Permanente’s medical campus in Oakland.

 

Amid the bustle on a recent weekday, a stocky security guard returns to his post with a pair of fat onions. A surgeon in scrubs comes to check out the honey stand. “But have you tried a pluot?” asks a man with a canvas bag tucked under his arm. He follows up with an explanation of the difference between a pluot—more plum than apricot—and an a prium—more apricot than plum. Turns out, the pluot expert is none other than Dr. Preston Maring, a Kaiser Ob-gyn and administrator and founder of the Kaiser farmers market project.

 

There were 4,385 farmers markets in America in 2006, an increase of 18 percent since 2004, according to the U.S. Department of Agriculture. Today, only a few dozen are located at medical facilities. But if Maring, a 36-year Kaiser Permanente veteran and the Johnny Appleseed of hospital farmers markets, has his way, there may be many more. An enthusiastic home cook, Maring, 62, was used to shopping for ingredients at weekend stands set up by local growers. He was also used to seeing jewelry and trinket vendors in the halls of his hospital. He reckoned, why not add a few organic greens and nectarines to the mix?

 

“I was kind of curious,” Maring says. “You’ve got 3,000 people that come together in this building every day. What would happen if you put a farmers market in front? Would people stop and shop? Would the farmers do well? What would the impact be?”

 

Since the first weekly market opened in Oakland in May 2003, farmers markets have sprouted like chanterelles at 32 Kaiser sites in California, Oregon, Washington, Colorado, Georgia, and Hawaii. Maring was directly involved in setting up the first 15 or so. Then the idea took off. “That was a great day because it meant word got around within our program,” he says. “Other people at other facilities of all job descriptions put in a lot of energy and opened those markets.”

 

Kaiser isn’t the only health organization that sponsors onsite sale of local produce. Seasonal markets have sprung up at the two branches of St. Charles Medical Center in Oregon and at three of New York City Health and Hospital Corp.’s sites, to name a few. But Kaiser, a leader in the trend of promoting wellness, is a trendsetter here as well. And the administrators of the nation’s largest not-for-profit HMO think that providing high-quality produce—whether to take home or serve on hospital patient meal trays—is a way to help. Heart disease, diabetes, osteoarthritis, stroke, and some cancers are among the serious health consequences that have been linked to a poor diet.

 

“A lot of Kaiser Permanente’s history is about prevention in terms of all of our cancer-screening programs and diabetics screening and cholesterol screening and all that,” Maring says. “It’s clear that there’s nothing better for our patients and for the program than preventive medicine. And good food obviously is the foundation for good health.”

 

Kaiser also wants to give “hospital food” a better name. The HMO is working with dozens of small, independent farmers to provide sustainably farmed produce for patient in its California hospitals. By the end of 2007, about 25 percent—or 50 tons—of the fruits and vegetables served to Kaiser’s hospital patients in Northern California will be supplied by small, pesticide-free farms that follow sustainable agriculture practices. Over time, the HMO plans to extend the scope of this pilot project to other regions. Given “the size of Kaiser, when we do something like this, the impact it could have is enormous,” says Jan Sanders, Kaiser’s national dietitian.

 

What vendors charge for the produce depends on the site. At the Oakland market, prices ranged from a few cents above to a few cents below what comparable produce cost in local supermarket chains. There’s evidence that Kaiser has found a good recipe for improving public health. Some 71 percent of 1,200 shoppers surveyed at 17 Kaiser farmers markets in 2005 said they were eating more fruits and vegetables since they began shopping at the markets. Another 63 percent said the markets had tempted them to try eating something new.

 

“I believe from what I was able to gather from that survey that having fresh fruit and veggies right in front of you when you’re walking from the parking garage to your job makes a difference,” Maring says. “You know it’s hard to walk by a big basket of fresh arugula even if you aren’t sure what to do with it.”

 

As for Maring, his impact is felt in ways big and small—from the woman who dropped four dress sizes to the inner-city neighborhood that’s seeing their dinner tables transformed. Shortly after the Oakland market began, he started emailing a weekly farmers market newsletter to the staff at his hospital. Several months ago, he upgraded to a blog with recipes he concocts from what’s good at the market that week. A reader might stumble upon tips for mincing garlic, the best way to roast a pepper, or the trials and tribulations of using a blender to puree soup.

 

Joyce Stafford, a secretary in Kaiser’s genetics department in Oakland, is one of the 11,500 subscribers to Maring’s blog. Between following his recipes, taking regular walks around nearby Lake Merritt with her colleagues, and keeping healthy snacks in her office, she says she’s dropped 55 pounds. “We love this farmers market,” she says. “A lot of us come and taste-test the fruits at lunchtime. It’s like a little outing.”

 

But many don’t have such luxuries. In many neighborhoods in the United States, processed foods are easier and cheaper to come by than the healthy stuff. That reality is in part why Kaiser in July partnered with a handful of agencies and community groups to launch a farmers market at a park in the Watts district of Los Angeles. Before the opening, there were precious few places to get fresh produce in this lower-income area, according to an Occidental College study. Most of the people living in this part of South Central Los Angeles are Latino or black, two groups prone to obesity, heart disease, and diabetes.

 

“It’s pretty dismal in the community of Watts, especially if you don’t have private transportation,” says Joanne Robinson, director of the Kaiser Permanente Watts Counseling and Learning Center. “There’s one full-service grocery store, and the produce isn’t always the freshest. There are a handful of pushcart produce sellers. Balance that with the 50 fast-food places and 39 liquor stores in the area.” Instead of placing a market a few miles away at a Kaiser hospital, the HMO partnered with community groups to bring a market to a popular park in Watts. Robinson says they recognized the need to give neighbors fresh choices. The market now occurs once a week at Ted Watkins Park.

 

“Making a change in what you eat and what you prepare doesn’t come easy,” Robinson says. To help provide some inspiration, Kaiser and its partners have brought in cooking demonstrators ready with recipes to appeal to African-American and Latino shoppers. “There’s this woman called the Seed Lady of Watts who made tacos out of beet greens and kale,” Robinson says. “All the kids and parents were gobbling them up.”

 

Robinson recognizes that it will take time for the Watts market to build a following, but it’s worth it. “We’re hoping this exposure to healthier options will increase people’s demand for better food,” she says. “We want everyone to have the same nutritional opportunities as people in more affluent areas, to have the expectation of better and not just settling.”

(Click here to view a companion photo essay)

 

Teresa Moore is an assistant professor of media studies at the University of San Francisco. She writes about health and race.