A Michigan systematic review of produce-prescription programs implementation and associated effects on health and food security

Abstract Michigan runs one of the nation’s longest and most varied portfolios of Produce Prescription Programs (PPPs), which provide fruit-and-vegetable benefits to patients facing diet-related chronic disease and food insecurity. Despite more than a decade of starting these programs, no synthesis has examined how these interventions are delivered statewide or whether they meet their stated goal of consistently improving diet, cardiometabolic risk, and local economies. We systematically reviewed implementation models and quantified dietary, clinical, and economic outcomes reported for Michigan PPPs implemented between January 2010 and May 2025. We searched PubMed, Scopus, Google Scholar, and targeted grey-literature sources (state health-department sites, farmers-market association reports, media releases) for English-language records published January 2010–May 2025. 81 unique records were independently screened by two reviewers; discrepancies were resolved by consensus. Initial screening yielded 43 documents, and 16 met our prespecified inclusion criteria. Data showed that uncontrolled diabetes participants increased their fruit and vegetable intake by 0.70 to 1.0 cups per day and reduced their HbA1c levels 0.7%. Mean systolic blood pressure (SBP) of participant children also fell 12 percentiles. The data from the included programs recorded redemption rates over 90% of vouchers, and varying funding expenses. The short duration of the intervention periods prevented reports of significant reductions in BMI. The short follow up durations of included materials restricted the ability to observe long-term weight loss and/or cardiovascular health improvements. Overall, PPPs in Michigan show significant increases in fruit and vegetable consumption, improvement of selected clinical markers, and increased revenue for local food systems.