GROUNDED Live - 2026: Steven Chen - Food as Medicine: Why Sourcing Matters

Welcome to a new season of GROUNDED Live. This season features presentations recorded at GROUNDED Festival 2026, held over two memorable days on Yan Yan Gurt West Farm in Victoria, Australia. Each episode captures the ideas, stories and practical knowledge shared by the farmers, researchers, chefs, practitioners and thinkers who came together to explore healthier landscapes, healthier food systems and healthier communities.

In this presentation, Californian physician Dr Steven Chen explores the growing evidence linking the food we eat with our long-term health and wellbeing. Building on conversations around nutrient density and regenerative farming, Steven explains why where our food comes from matters just as much as what ends up on our plate, inviting us to see farming and medicine as more closely connected than we often imagine.

See Steven's PowerPoint presentation here.

GROUNDED Festival is a cross between a farming conference and a food festival, held on a different farm each year. Every festival is unique, celebrating the people, landscapes and food of its host region through an inspiring line-up of speakers, local producers and hands-on learning.

With multiple stages running concurrently, GROUNDED brings together science and technology, ancient wisdom and fresh thinking. It provides a respectful place for lively discussion, an audience as interesting as the speakers, and an excellent menu of local food, drinks and music, all on a beautiful, regeneratively managed farm.

Each year, we record many of the presentations and make them freely available as the GROUNDED Live podcast. We hope you enjoy the conversations.

Thanks for listening, and if you enjoy this episode, we'd love to welcome you to a future GROUNDED Festival.

Transcript

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SPEAKER_00 0:05

G'day there, I'm Matthew Evans, and I'm the founder and curator of the Granted Festival. And what follows is the Granted Podcast, and this is the audio that we capture from the speakers in the tens live on the debate unedited. And we hope you enjoy it. The food we grow effects, the nutrient density within it, and how it might affect our brain. We brought in a guy named Stephen Chen for Grounded 2026. Now he's a medical doctor, he's based in California, and he's talking about food as medicine and why sourcing matters.

SPEAKER_09 0:46

Welcome back, everyone! Please take your seats. We're about to start the next session with Stephen Chen MD. For those of you who are just arriving to this tent now, my name is Anthony James, host of the Regeneration Podcast and Confluence River Journeys and a few other things, and honored to be the Iron Bark Tent host here today. Especially with people of the caliber of this guest. So we are about to hear from our second international guest for today, Stephen Chen. Stephen's the chief medical officer at Alameda County Recipe for Health. That's a nationally recognized food as medicine program embedded in federally qualified health centers. Prescribes regenerative andor organic produce paired with health coaching to treat, prevent, and reverse chronic conditions and food nutrition insecurity. By intentionally sourcing food from local regenerative organic farms, Recipe for Health creates a health multiplier effect for people, economies, and ecologies. And from the little I read up on it, that is an understatement. Would you please give a massive hand for our next guest, Stephen Chen MD.

SPEAKER_05 1:58

Thanks so much. Thanks so much. Really pleased to be here. Thank you all for welcoming me from California in the United States. And I wanted to start just to get to know the audience a little better, um, through a little stand-up uh opportunity. Okay, and so this is really to help see and make visible the invisible to hold all of the complexity in this room through the representation. And so I'm gonna try to show the arc from soil to cell, from soil to cell. And I want to ask first for the growers, the the producer, the farmers or ranchers to first stand up. Who is in the room that is a grower or ranch or farmer? Amazing, right? This is what I would expect from this conference. Wonderful. So just look around and notice the growers or farmers, uh, the ranchers. Thank you. Who are the if I would say the supply chain people, right? The food hubs, the aggregators, the uh people who are uh driving and doing the logistics be to get the product, the food, the the meat, the whatever it may be, to market. So we got one person, two, three, stand up, please. And just notice this is the missing middle, the invisible supply chain that nobody talks about, right? But important to see because they're part of the food is medicine story. Who are the patients? I guess probably all of you would stand up, right? So we got the patients or soon-to-be patients, and you'll see why from my talk. And then let's now enter into the healthcare space, right? From soil to cell. Who are the nutritionists in the room? Are there nutritionists? Can you stand up? We got our we are our colleagues from Western Public Health here. All right, wonderful. Wonderful. And then how about nurses? Wonderful. Nurses, very good. And then doctors, nurse practitioners, clinicians. Do we have any besides myself? I see one, two, three, okay. Naturopaths, right? Acupuncturists, healers. So we're kind of all represented, but we are all siloed out and we don't actually know that kinetic chain from soil to cell. But if we can put it all together and design systems and programs around that, we will get a health multiplier effect. So I'm gonna talk about that. So I just wanted to start with that. And then I don't know if you can actually see the screen. Can I just do a sound or a visual check? For folks in the back of the room, can you actually see the screen? Not really. Oh, this is gonna be interesting then. I'm gonna have to I'm gonna have to go a little ad lib here. This is the title of my talk is Food is Medicine, Why Sourcing Matters. And I would actually add the word regenerative food is medicine, why sourcing matters. And so let's begin. Um, today's journey, I'm gonna be a little didactic with a little interactive, just so you have a sense of where we're going. Uh, I'm gonna do a little social biography, a little background on myself. I was asked to do that. I don't usually start with me, um, but I guess people want to know about me, and it'll probably help just to understand my lens. I will also then go into what are the challenges that we are confronting from health, food, and agriculture. And then I'm gonna go into what is food as medicine, right? Is this popular here in Australia? Is it not? What is it? And then give you an example of what we're doing in California in the United States with our program. It's called Recipe for Health. And how food as medicine, using R as a case example, can address and confront all of these challenges. Are we good with that story, that arc? Are we good? Okay, so a little about me and how we came to this space. Um, you know, I stand as uh on the on the shoulders of my family. So my you if you can't see this, this is a um an image of Taiwan, the the island of Taiwan, where my grandfather, uh who was a farmer, third grade educated, illiterate, taught himself to read, and was the smartest, wisest man in the village. He had a son, my father, who then got a scholarship to come to the United States to study civil engineering, a PhD. And this is after 1965. That why is that important? In the US, we had immigration laws extending back from 1882 that were excluding Asians all the way up to 1965 when we realized it was hypocritical if in this new world order at the time, if we were going to be doing this. And we were losing in the US the space race against the Russians. And so we needed to import labor, uh uh kind of intellectual labor. And so it was this brain drain, this brain drain of folks who are highly educated to come do PhD programs. So that's my dad came through that pathway. And then I was born, and my brother and I were born in California, and we've been there all the way through. I say this because I think it's important to understand not just me as an individual, but that we all have lineage. Um, and so if I were to ask you, what is your social biography? How do you fit in to this work? You can trace that. And we saw that in the previous speaker, talking about her uh connection to the Irish and to England and now in New Zealand. Uh, I also say that um, and just to introduce myself in in various languages, so I would say my name in Taiwanese as Washi Tanipo. And then if I were to say it in Mandarin, I would say Warsu Tanipo. Um, so that's that's a little about me and how in my history and how I come to this work. I am not uh a green thumb. My my grandfather was the farmer, my dad is a green thumb, they I watched them you know plant and do gardening, and then I went off to medical school and I'm kind of I was disconnected. And I'm this has been a journey of reconnection as well. So then I talk about, well, what was I doing after, right? Um kind of in this medical space. A lot of my work has been as a family medicine doctor. I trained in family medicine, I did a fellowship in integrative medicine. I was doing downstream care, taking patient, taking care of all our patients in our federally qualified health centers. Those are our safety net clinics. I don't know if you have them here in Australia, but we serve um folks without insurance, the most poor, the most vulnerable, folks who are undocumented. That has been always my work, always uh the way that I've wanted to do work because I saw how it was for my grandparents to struggle through uh the healthcare system in the US. And so that was a lot of downstream care, diabetes, depression, hypertension, all of that stuff. And, you know, there's this little picture here, and you can't see it, but it's it's a person mopping the floor uh with a medical assistant. That was me, myself mopping the floor with a medical assistant, and water overflowing and just we're just mopping every day. And it felt like that's what we were doing every day to take care of patients. Everyone, all these sick patients were coming in and were just daily with 15-minute visits, trying to take care of patients and not seeing the faucet that was just overflowing and continuing to send us business. That was downstream care. And then I wasn't had an opportunity to get into this food as medicine and begin to move upstream. And I can go more into the story around that, but I got a call. Um, in 2000, I started running one of the medical centers, and I got a call from a county supervisor. Uh, in California or in our states and these counties, you have five people that run the county. And I was asked by supervisor Wilma Chan, and there's a picture of her here. Um, and she helped, she was, she was the person responsible for helping to scale what I'm about to share with you all. And she said, I want you to um come and present your work on food as medicine, because we're doing that downstream care, but beginning to bring food as medicine in. And so I spoke to the county supervisors and I made my case, and I, this is in 2016, and I closed with a statement saying to the supervisors, imagine if healthcare paid for food as medicine. Just as healthcare pays for your antibiotics or for your blood pressure medicines. And that was my throw down the gauntlet moment, and I walked out, right? And then she called the CEO of our health system and said, Hey, how do you kind of can you support this and build more of this stuff? And we played around with it. But ultimately, three years later, she called and recruited me to join the county. And I said, Well, why do you want me to do this, Supervisor Chan? What's your vision? She said, You know, I want you to build what you've done in your health center. I want you to build it across the county. I want you to take it with me across the state. She was a former lobby, uh, former uh policymaker. I want to help me um advocate for this at the state. We'll write bills together and you're gonna testify, which I did. And then I want you to take this nationally. And so we've done some of that work too. And then she was hit by a car. Um, and it was like, wow, what's gonna happen now? Well, the good news is our county continues to invest in the program because of her, we want to follow her legacy. So that's just a little biopsy or biography, if you will, uh social biography of my story and coming into this moment. And you're all probably going, what is he talking about? What is this food as medicine? So hopefully that just gives you a sense of the subjectivity of what I'm about to share from my my space, my story. So I'm gonna now just talk about what are we actually dealing with? And what I'm gonna share are data from the states, which may have some connection to what we're seeing in Australia. So let's start with health, the health challenges. Um, but also let's start with the system silos. Again, you can't read this perhaps, but it's basically saying system silo challenges, food, ag, and health. And I'm gonna quote Wendell Berry. Do folks know who Wendell Berry is? Okay. Some he's a farmer, an environmentalist, a poet, a right uh and an incredible thinker. And he says people are fed by the food industry, which pays no attention to health, and are treated by the health industry, which pays no attention to food. Does that ring true to folks? Yeah. In medical school, I got zero training on how to use food to help my patients. And I I just spoke with some of the folks at the Western Public Health Unit and um and Sunshine Hospital earlier this week and asked a similar question. And it was still with the Australian doctors, a zero, a big fact zero in terms of their training. I like to add this line both the food and industry, uh, food and health industries pay no attention to the land and soil. And as I have heard many presentations here and and in the Australian kind of perspective on land, I think this reading is so true. You all have an understanding of country and of land. You're also having an understanding of soil, they're not the same. And in the US context, land and soil are not talked about. We might talk about food. We might talk about health, but we're not connecting it to the land and the soil. I would like to just submit that regenerative food as medicine has the power to bring all of these silos together. And that was my reason I did the soil to sell exercise. We all live in our silos, but we have to bring it together to actually face what I'm about to share with you, which are the health challenges and the ecological challenges. So I'm just going to give three highlights in terms of health conditions and what we're up against. That's a picture. The first picture is of um a supermarket in the US. And so the main point here is unprocessed or ultra-processed foods. The second one is food insecurity, and the third is chronic conditions. So those are the three health challenges. What do I mean by that? In the US, six in ten of us in this room, or six and ten of us in this room would have a chronic condition. Actually, a chronic disease. That doesn't even include, though, and if you look at this, if you were to see this, this chronic disease list is all the downstream diseases like diabetes, high uh cancer, stroke, kidney disease, all of those diseases. This does not even include conditions like high blood pressure, obesity. Those aren't necessarily diseases. So we're actually sicker than we say than we are here. In the US, in terms of metabolic perspective, only maybe 12% of the US population is optimally metabolically healthy. Only 12%. So chronic diseases here in our country, I don't know what the numbers are here in Australia. This is a data slide, so I'm going to describe it, but it's an important data slide. An unhealthy diet is the number one driver now for death, for mortality in the US. We're often taught, oh, it's smoking. But if you if in this in this image, and I'm going to come off the stage now just to try to describe it, this is a graph, and it basically has on the y-axis a bunch of risk factors related to death. And it stacks who's the what's the number one contributing risk factor? And you'll see that dietary risks actually is the number one. It surpasses tobacco use. And you'll see on these ex and and high blood pressure, and on this bar graph over here onto the right, all of these blue-colored boxes, this is the number of people dying per year in the US. We're talking about 500,000 people dying per year because of an unhealthy diet. On all these blue bars are all of the chronic conditions that we're dealing with. So food is critical to who we are and how healthy we are or unhealthy we are. And then I would like to just say then that the process ultra-processed food environment in which we're in, you're going to hear some of that tomorrow, um, is really a contributor too, right? So ultra-processed foods in the US, over 50% of our population uh calorie caloric intake is ultra-processed food. Some say 70%. I hear that in Australia, is it 30% or 60%, 40% around there? So you guys are doing better than us. Um, but this this ultra-processed food is responsible for 32 adverse health outcomes. And again, this is more of a detailed slide, right? For those who want the science, but we'll see if, for example, and I'm gonna come down here again to show if you have a processed ultra-processed food diet, you are at risk from dying, uh an increased risk by 21%. Just all-cause death, whatever is gonna get you, you have an increased possibility of that. For heart disease, you're at an increased risk of 50%. For mental health, anxiety, you're gonna increase to 48%. So the food we eat has a direct impact on our health and unhealth. And then the the typical one, diabetes, right? Diabetes is 12% where it's increase. So we have the food itself, we have ultra-processed foods, and now we have in the US inadequate fruit and vegetable intake. And this is where we get the farmers in the house, right? Imagine a whole food system that is growing healthy fruit and vegetables for us as a at a population level. In the US, only 10 to 12 percent of the population at gets the gets what we need in terms of recommended fruit and vegetable intake. And I just learned in Australia it's three to five percent. So in this this metric, you guys are doing worse than us, right? So why does that matter? And so can everyone raise their fist? Just look at your fist. That is my way of telling when I'm in the room with my patients one serving of fruit and vegetable. That's not perfect, but it's a simple way. Every fist increase in your in your intake of fruit and vegetable intake of by one fist is a five percent reduction in death, all-cause death. So if we gave this a five a day, five fruit and vegetable intake a day, five, that's a 25% reduction. That's why fruit and vegetable intake matters. Right now, this is all epidemiologic data. And that's what this you know fancy curve shows, right? It's it's basically showing there's there's less death in in 5% intervals. And in fact, uh some studies show that if the US population increased fruit and vegetable intake by one fist a day, just one fist a day, one serving a day, we would have we would save 31,000 lives. Just just that in improvement. So imagine you as farmers growing this type of food at scale, what you're doing for our communities in terms of population health. And then I'll just name food insecure. I'm hearing that it's a big issue in Australia. It's a big issue in the US. Um, one slide just to show that the more food insecure you are, the higher chance you're gonna get chronic disease. And the example slide that I like to talk about, the example is if you come into my clinic as a kid or as a pregnant woman and you have zero conditions, zero disease, but we identify you as having food insecurity, you have a twofold risk of developing diabetes over time. So it's an upstream identifier to help us improve population health. All right. So that's that's that's the doom and gloom of health, right? Of the challenges we're facing. The ecological pieces are also kind of doomsy as well, right? It's because of the way we farm and ranch conventionally, I would say, some of the practices there that are leading to the degradation of soil, the degradation of water, and uh warming planet. And I'm gonna spend maybe less, you know, just kind of blow through these parts because I think this audience probably gets it. When I'm in front of healthcare audiences, I have to show the data and explain why this is connected. But certainly when it comes to soil, all of most of our food is grown in 95% of our food is grown in the topsoil. And yet we're eroding our soil because of the way of our farming practices and other other issues. But some say that uh topsoil will be gone, uh, our tillage and all of those pieces, that our soil, our toll, our soil quality, our soil ability to grow this food, the topsoil could be lost in 30 years, right? So, how are we gonna grow food if we don't have soil? Water. That's another area for degradation. All of that nutrient runoff from the nitrogen, the chemical pesticides, et cetera, not the pesticides, but much more of the nutrients of the fertilizers, the nitrogen, goes into the waterways and is responsible for 78% of this fancy word called eutrophication. That's where the waterways are now over enriched, and we get too much algae with these algae blooms. Our waterways are are not um are not we're not able to drink that water. Uh there's dead zones in like the Gulf of Mexico, contaminated fish and soil, and and and uh shellfish. So not fit for consumption. So that's from a water perspective. So we just talked about soil, we talked about water. And I'll be curious. I really want to hear from the farming community if I'm overstating this, right? Because I am always trying to explain more of this to the medical community. So I welcome pushback, or if I need to be more nuanced or I need to be more overstated. Either way, let me know. Um, and then I would just say the climate piece. 31% of our greenhouse gases are from the agri-food system. That's huge. This is from the FAO. This is just out there in the world. In healthcare, when we try to green healthcare and try to make it more sustainable, we're only fixing 5%. Now imagine if healthcare started to engage agriculture. Could we reduce the agricultural input by the 31%? And you all know this better than me in terms of the emissions. You know, when I was in Japan in September, I met with Professor Dale Manami, and he was one of the three scientists that discovered nitrous oxide uh from our nitrogen fertilizers. And he explained the pathways. And he he got the Nobel Prize. He was one of the IPPC Tim members that got the Nobel Prize in 2007. And it just became so clear when he explained it to me how the beauties of nitrogen allowed us to feed the world, but it also has downside effects. And so when you're having all of this nitrogen fertilizer then becoming converted into nitrous oxide, which is 256 times worse than carbon dioxide, we have a problem. I'll just share then, and I'll close this ecological part with a human health piece on agriculture. We know that farmers who are exposed to pesticides have a higher risk of various cancers. And I'll read the ones down here because you can't read it. Associated with breast cancer, bladder cancer, prostate cancer, multiple myeloma, lymphoma, and leukemia. So that's it for our farmers, for our people who are and our farm workers were exposed. But what about the rest of us? When we eat food that has pesticides on them, different thresholds, we know that we can detect that pesticide in the urine. In 90% of you, we would find pesticides in your urine. A study that was done in Berkeley where participants then ate for six days 100% organic diet, there was a 61% average reduction in the pesticides that were detected in our urine. Now, there's a lot of research that needs to be done as to, well, what does this mean? Does this have health impacts, or are we just totally resilient and we can handle the burden? What does this mean? So there's there's work to be done, but there's a signal. Something is happening in our bodies, even by the food that we consume. Now, certainly, any fruit and vegetable is better than a Twinkie or the or a is it a Tim Tam, Tim Tim? One of those, right? Like we know that. But let's look beyond just a regular, like conventionally grown vegetable. Can we get the other benefits by the way that we're growing the food and connecting that to healthcare? And then this is an easy public health piece. Nitrates in the water, right? The nitrates from the nitrogen fertilizers polluting our groundwater, et cetera, that's associated with colorectal cancer, thyroid disease, and neural tube defects. Okay, so that's a lot of doom and gloom, right? Oh wow, this is this is heavy. How are we gonna solve for this? I'm gonna submit that we have hope and that a regenerative food as medicine model that you are all part of and can be part of can meet these challenges and meet that moment. So I'm gonna now go into what is food as is medicine, and then I'm gonna close with Recipe for Health and give you some results. Um, what is food as medicine? I like to say that it is basically food-based interventions integrated into healthcare. So we in healthcare will prescribe food to what to do the following, to treat, prevent, and reverse chronic conditions. This is not just prevention. People often tell me, oh, you're talking about food and vegetable intake, you're just doing prevention. No, no. I'm actually using this in the clinics to take care of patients with diabetes, heart disease, depression, to treat their conditions, wherever whatever stage they're in, and have seen reversal, which is pretty powerful. In the US, we have a pyramid, we would say, of describing the interventions of food as medicine. So when people say food as medicine, what do you mean? Well, at the bottom, it's it's a bunch of policy-level choices around how do we do food policy. One step under, uh kind of going up the pyramid, you'll have nutrition security programs and nutrition assistance programs. We call it SNAP, it's kind of like food stamps. I don't know if you have something similar in Australia. You're providing food for food insecure patients and populations. One step above that is where my program sits: produce prescriptions. We're prescribing produce. And then another step above that is medically tailored groceries. And the final step at the top is medically tailored meals. Medically tailored. That means it's overseen by a nutritionist. They're designing the foods, usually for sicker patients. I'm in the primary care ambulatory space, taking care of the whole family. And so I'm using produce prescription, but we can use the other interventions as well. Okay, so what's cool about the ability of food as medicine and a regenerative food as medicine model to address the silos is the following. Again, this is a picture, and I I know it's tough in this with the glare and everything, but I'm gonna kind of come down and explain it. So regenerative food as medicine can address multiple determinants of health. When I'm in clinic seeing patients with diabetes, obesity, hypertension, I can use food as medicine. I can prescribe. When my clinic is thinking about addressing a population or trying to move upstream and address food insecurity, social isolation, I can use food as medicine. When our policy teams are looking at structural determinants of health around food, housing, economics, racism, all of these structural and policy pieces, food as medicine has a role. And then from an ecological determinants of health, food as medicine has a role. You as farmers know that. If we can grow the food regeneratively, we can improve the soil, have less soil loss, less extreme weather, the water issues, all of that. So there's a there's a whole through line from sourcing food grown the way that you grow the food here through many of you to get it into our clinics through this regenerative food as medicine model. Okay, I know I'm talking a lot at you. I don't know if you guys are following or if it's boring. Are you following? Can I just get a thumbs up? Is it good? Are we okay? Okay, good, cool, okay, good. All right. Um, I'm now gonna just close then really with the model that we're doing in Alameda County. And it's called Recipe for Health. And I'm gonna share how we are addressing these challenges. So, what do I what is recipe for health? When I describe this to patients and clinicians alike, and I say it's pretty simple. We are prescribing food and health coaching. Food and health coaching. It's a prescription for food and health coaching to treat, prevent, and reverse chronic conditions and to address food and nutrition insecurity. It's not any food, though. It's not just any special, it's a special type of food. All of our food is local and we categorize locals within 250 miles. It's organic, regenerative, and from as many BIPOC farmers as possible. BIPOC is in our country, it's black, indigenous people of color, really trying to ensure that um all farmers, but farmers of color especially, have an opportunity. In our country, the U.S. um farming system has a bad history around racism and and stratification for farmers. I don't know if that's the case here in Australia. So we we center our BIPOC farmers as much as possible. We combine that with health coaching. How many of you need coaches in general, right? Just to get through life. It's not, it's not it's pretty expensive to get a coach, right? But imagine, and this this is in our most underserved settings. We get our we are supplying our patients with not only the provision of food, this nutrient-dense, rich, delicious, fresh food, but the opportunity to get coaching, to support them on movement, nourishing, connecting and being. That's it. That's the model. Now, the why behind this model is what I said earlier at the beginning around soil to sell and the whole idea of a health multiplier effect. So recipe for health and any food as medicine program, and I encourage you all as you develop your food as medicine programs to really source regeneratively, organically, et cetera. When you do this, you get more than just human health. And so, because of our sourcing strategy, which is local, which is organic andor regenerative, which is prioritizing BIPOC farmers, we get this health multiplier effect with multiple co-benefits. I call it H cubed E. It's a little nerdy. H cubed E, the three H's and an E. What do I mean by that? Well, H, the first H is human health. That's like myself and you as a patient. That's easy, right? You're gonna get benefit. But then if you take a ripple beyond that, it's the farm worker and the farmer who's gonna get benefit because of the way we grow the food. And you take a uh a further ripple beyond that, it's the community that's gonna have less pesticide drift. We see that in California in our Central Valley. Our Mexican-American communities who are not necessarily the farm workers, but are getting it, are getting the effect of all of that pesticide drift into their communities having an effect. You can look up the Chamaco study if you want to know the health effects of that. So that's the first H, human health. The second H is economic health. And now we're talking economic health for farmers. We want to pay farmers strong wages, thriving wages. We want to create, use this new market to create opportunity. And I'm gonna share more about that and some of the outcomes. But the health system gets some benefits from an economic health. And then the patient who now is getting food weekly dropped off at their home, this produce box, and has now disposable income for other things. And then the final H for the HQD is the ecological health, and that's the soil, the climate benefits of growing food regeneratively and organically. And then finally, we have E, equity, HQD. We are very clear that we want an equity-centered approach as we design food as medicine that sources food this way. And I would just say that when you when you start and design a food as medicine program with HQD in mind, you prevent an economic race to the bottom. And you won't be able to see this picture, but this picture is um what my children get at a school meal, a free school meal. So school meals in the US, unfortunately, do not take this approach. I think they're reimbursed $1.33 per meal. So you can't really get great food. So what do you get? You get um cereal. This is frosted flakes, cereal, you get muffins, and some tricks bars. Like I guess that's like a Tim Tan, maybe. Um, but that's a metabolic bomb that is causing the fatty liver, the prediabetes, the obesity in our in our kids. And they're gonna be coming to my clinics. So we have a we have a lesson to learn. If we embark on food as medicine and we don't source regeneratively, organically, et cetera, we may go into this commodity approach to food as medicine that doesn't benefit the farmer and that's it doesn't necessarily benefit the patients. I'm gonna close with uh I'm gonna say a few things on the build behind this, right? And just to give you a flavor for how it looks, it's one thing to talk about a recipe that does food and health coaching. Well, how do you build around it? So, like any good recipe, you have ingredients, and we have six. The first ingredient is our Safety Net Health Center. If we start this work in healthcare, this is not a food systems team trying to figure this out on their own. This is healthcare, doctors, nurses, nutritionists, the belly of the beast of healthcare, integrating food work into their work. We have a food pharmacy. Notice how I spell pharmacy, spelled pharma, F-A-R-M, pharmacy. And I'm going to tell you more about that. We also have a behavioral pharmacy, and I use the word pharmacy intentionally. The behavioral pharmacy is a health coaching. Because doctors and nurses and nutritionists, etc., we understand the concept of pharmacy, right? So if I prescribe one of you an antibiotic, where do you take that prescription to a pharmacy? It's it's available, hopefully down your street. You don't have to pay for much money, it's there. If you don't have that pharmacy, what are you going to do with that prescription I write you for that antibiotic? You can't execute on it. You can't fulfill my prescription for your health, your doctor's prescription for health. And yet, isn't that what we do in primary care when I take care of patients? We say, oh, go eat better. You know, go find some social support. We're essentially sending patients off and they don't have a pharmacy in place. So we we we thought about, well, let's create a food pharmacy, let's create a behavioral pharmacy, let's link all of these ingredients together, let's figure out how to fund it. That's the fourth one. And we can talk about how to fund it. I'm gonna have a slide on that. And then the fifth one is someone has to bring this all together. And that's my team at the county. We are the training administrative hub that coordinates, that builds all the workflows, that makes this thing like a flywheel and flow. And then the last piece is we have the community. And so there's a lot of community and public health programs that can then integrate into this. All right, so that's the model. I'm just gonna share with you what it looks like in in Alameda County. Alameda County is um 800 square miles, it's about the size of Rhode Island. We have about one point, what do I have here? 1.65 million residents, uh 57 different languages. Um, our work of Recipe for Health is across 21 health centers or 21 clinics across five different health organizations. And they're listed there. Native American Health, Tobercio, all these amazing health centers that said, yes, we want to partner and do medicine this way with you. This is a map of the United States and its territories. I think we have an opportunity for local health centers to be connected to local farms, especially local farms that are growing regenerative and organically. Imagine that, that health centers are creating demand from farmers and paying the farmers to grow the food for us to take care of our patients. In the US, we have 1,400 of these health centers, 19,000 different sites. So imagine that engine. What does it look like in Australia? I don't know. And then the third, the second ingredient is that food pharmacy. So we partner with uh an organization called FarmPreshDU. They are a network of farms, a network of farms. They're across the whole state. They have a network of 110 farms across the state. Because of our sourcing strategy to go to pick to choose only local farms, we've narrowed it down to 45 local farms that can service us in Alameda County. We are paying farmers as pharmacists, F-A-R-M-A-C-I-S-T, right? Living wages, thriving wages. Um, all of the food is organic at minimum, and some regenerative and some regenerative organic. And it's this nutrient-dense, incredibly delicious, fresh produce that's delivered discreetly last mile to the doorsteps of each of our patients. So we are delivering this food weekly. When I write you that prescription, you're getting it, and you agree to it, you're gonna get a weekly box arrive at your doorstep for 12 weeks. That's the dosage. It's all covered by healthcare and paid for by healthcare. It's all covered by healthcare and paid for by healthcare. I can re and if you need it for another 12 weeks, I can I can do that. I have to battle that out some of the times with the health plan, but it is possible. And we're also enrolling you into um into food security programs. This is an example of one of our farms. This is Tony Serrano, um, amazing man, Mexican-American man. He has Jazz Family Farms. He is regenerative organic certified since 2014. We could all have a whole conversation on certification or not. I'm actually okay with non-certified as long as they're doing the practices. Um, Fair Trade certified as well. He's in Salinas and Hollister, and uh, it's in California, 406 acres. He's just one of the 45 farms. Amazing man. The third ingredient is the behavioral pharmacy, and that's our health coaching team. We partner with the community-based health coaches called open source wellness. And these are um these are incredible health coaches that are doing this, this whole issue of sustaining behavior. It's one thing to give someone food, but what do you do if you don't even know what the food is? How do you coach and nudge people to support their behaviors? And this is what I was saying earlier in primary care and you know, we tell people, hey, you better go find some social support. I'll see you in four months. And then patients come back to us and we're like, well, what happened? It kind of nothing happened or it got worse. Because essentially it's that whole prescription to you, but you don't have a pharmacy to fulfill that prescription for my health. So we partner with this group, it's an amazing group called Open Source Wellness. They provide us in the clinic certified health coaches, and we do group visits. So imagine 20 of us are in a room. It's transdiagnostic. You have diabetes, you have depression, you have obesity, you have hypertension. We're all in this room together, and I have health coaches. I'm the physician, and I have health coaches, and we actually are not doing what I'm doing now, which is just talking at you. We're actually moving together with a movement coach. We're dancing and moving together to your to the best of your ability. There's always a movement piece. We're also um doing a nourish piece where whatever food that we just sent you that week with a recipe, we're going over it. I'm Mexican American, you're South Asian. What is this kale? I don't even know how to cook it. What spices do you use? So there's lots of learning from each other. We do a um a social support section where you're all in small groups. So all 20 of us now are in small groups with a health coach design and we're learning from each other. And then the health coaches are calling us weekly or texting us weekly. Hey, Steven, you said you wanted to increase your fruit and vegetable intake by one serving. How are you doing? What are the barriers? How can I support you? And then we do a mindfulness piece. So those are the four components of this behavioral pharmacy to support the food that you are growing for us. How do you pay for this? This is the fourth ingredient. Let me ask you, how much do you think the US spends on healthcare alone every year? Can I get audience participation here? A billion. A trillion. How much? 4.5? 1.5. The fourth largest economy in the world. What's the number behind that? How much? Five times the defense of it's it's uh it's 4.9 trillion dollars. We just spend $4.9 trillion. We're not doing cost savings, we're not doing cost uh cost effectiveness, we're just willing to spend that. Those GLP ones for anti-obesity, that's $1,500 a month for an injection. You know, all our Hollywood folks are using that, right? This is a lot of money. Healthcare is the sleeping giant that has been unutilized because we have not been trained on how to use food as medicine. In US, in the U.S., we have food policy that the the funding that undergirds our food policy and our ag policy is the farm bill. It's it's negotiated every five years. It's a it's a hot political button, and everybody fights for it. It's what leads to our corn subsidies, our all of our commodity food, right? It's it's undergirded by this. It's political football. How much do you think that is every year? 600 trillion? No, not that much. The Farm Bill is a is a legislative process that basically controls all of our ag policy, and it's funding renewed every five years. It's um for um for, for example, uh crop insurance, for um uh growing soy, cotton, uh, wheat, all of these things that are not uh that we sell to the rest of the world. Subsidies, that's one part of it, and and other pieces too. But essentially, just to give you the answer, it's it's 86 billion B. So it's a lot of money, but it's only 2% of healthcare. So imagine if healthcare took a sliver of that 4.9 trillion and actually invested in food and ag. And the virtuous cycle we could create, we could repurpose our American farmer, and I don't know if it would be the same here uh for the Australian farmer. We have an aged uh farming population, not a lot of people want to go into farming, but imagine farmers getting paid higher wages to grow healthy, nutritious food for our patients, and that healthcare helps to pay for that. And you get the health HQE nerd kind of health multiplier effect, right? Everyone's benefiting. Now you think is this just a California thing, right? It's that crazy guy from California. No. 32 of the 50 states now are engaged in some legislative or policy pathway to unlock healthcare funding. Poor food. So those are the 32 states. Is this a blue state or a red state thing? I don't know if you have that thing, but we're in a blue state, which are kind of the opposite of Trump. But we have red states. One of my colleagues is doing something similar in a red state, and it's taking off because the farmers want it. And our the current administration is very wanting farmers first, and that's wonderful. So this is a bipartisan issue in the US now. The fifth ingredient, and this is the non-sexy ingredient, right? This is the my team at the that's doing all the training and administration. So I've trained over, you know, a thousand clinicians now and healthcare teams on how to use food as medicine at a 15-minute visit. We've trained the medical assistants, those are the I don't know what you call them again in Australia. What's the word for the practice nurses? On to screen every patient for food insecurity in a culturally humble way. We enroll our patients in the nutrition assistance programs at the same time because we know that the prescription is 12 weeks and it may run out. And we do all of the heavy lifting. Everything's on electronic health record. It's the bane of our existence as clinicians. We make it easy. We make they don't have to fill out any authorization forms to get the health insurance plan to cover it. My team does all the back end. We do all these downloads and all of that. So we make it easy. The whole idea is how do we make this easy for everyone? Less friction for the clinician, less friction for the farmer, less friction for the health coach, less friction for the health plan that wants to pay for this. That's what we're doing to make this actually happen. So we've done uh 21 clinics, lots of lots of uh uh clinicians have been trained, and we have a 95% net promoter sore, meaning, would you recommend this training to your colleagues? These are busy clinicians. They're taking an hour out of lunch to do a lunch and learn to train with us, and they say, yes, worth worth the time to do this. I can now prescribe food as medicine with a click of the button for my patient with diabetes or depression. And some of this is all virtual. So now I'm just gonna close, then finally close, and then take questions on well, great idea, Stephen. All right, cool idea. Okay, cool, you're making it happen. But are what's this is actually is there any evidence behind this? Is there any impact? And that's why I use the HQB impact um model. So, from a human health perspective, I'm gonna talk with I'm gonna first start with Tammy. Tammy is one of our patients, and she says, My doctor told me about food as medicine. The first group visit, those are of our health coaching groups, gave me hope. It literally saved my life. It gave me my spark back. I started to care about myself and about others. Before, I was overweight and my blood pressure was sky high. I had stomach problems. All of that has cleared up. I'm walking, I'm doing those online Zumba classes. This is during COVID. We were doing all of these groups during uh virtually through Zoom. Uh my blood pressure is now within normal range, and I'm working to get off my medication. I've lost 77 pounds and I'm still going strong. It's just one patient. We've served over 10,000 patients now. We've um delivered 127,000 produce boxes. Again, we are delivering them to the doorstep. It's not my team, it's the farm team doing this. 2.4 million servings of regenerative and/or organic produce. And you remember what that one fifth serving can do in terms of all cause of mortality, a 5% reduction. From a human health perspective, and you know, I'm just trying to summarize, right? There's a lot, we have papers, we've written papers. Physical health, we are seeing reductions and cholesterol patterns. So two-thirds of our patients have a reduction in cholesterol patterns. It's non-HTL, it's a pretty important um indicator. From a mental health, and we'll talk about that tomorrow with Belise and I will be on a panel, Belise Jacka. Um, 44% of our patients reduce their depression symptoms categorically from one uh category of depression down. Same thing with anxiety. And then from a social health perspective, 24% improvement in food security. From an economic health perspective, and I know there's a few clinicians in the room, 15% reduction in emergency room visits compared to a control group. We actually had a control group. That's a lot. So you're providing this healthy grown food or healthy food grown regeneratively organically, you're reducing emergency room visits. Our farmers, especially our BIPOC farmers, saw a 60% increase in their product demand because of our food is medicine. So that's stable income. That's regular income. That's not finicky, like, oh, I that looks good, I don't want to buy it. We are buying it regularly. And then from a local economic perspective, uh, for every dollar invested in this work, $1.90 is generated for the state. From an ecological health perspective, we're we're actually creating, we have we've done soil health sampling, so we know that this we're we're looking at that, so we see an improvement in soil health, water health, we talked about that. And then climate health is something I'm very interested in. I'm wanting to test like how much can regenerative ag reduce carbon? Like, how strong is that argument? And then from an equity perspective, in the US, this is a graph of black farmers in the US from the 1920s to 1997, still an old graph. But we had about a million black farmers in the 1920s, and then it dropped down over time to about 30,000. And it wasn't just because people aged, it was actually because of racism. Our US Department of Agriculture acknowledged that there were structural impediments to black farmers having opportunities. 83% of our patients in our health centers are served are BIPOC identified. And we ensure that each through our contracting, each of our boxes of food, we have at least 63% of it is coming from BIPOC farmers. So that's how I'm gonna close and really just ask you how are you gonna bring a regen uh a recipe for health approach to your community? How will you join this regenerative food as medicine opportunity? And my information is there for questions and follow-up. Thank you for your attention. I hope I didn't just keep on blabbing and blabbing and blabbing, but I wanted to give you a model. Thank you, Steven.

SPEAKER_09 50:39

Any questions? Yeah, a couple bang right in front here, and then we can go to the back for a start, then we'll maybe go the other side.

SPEAKER_10 50:49

Okay, no, you go bang.

SPEAKER_03 50:51

Um, yeah, that was wonderful. Thank you. I'm sure a lot of us feel really inspired. Um great about the vegetables. I'm wondering if there's anything going on in the space of healthy meat versus factory farm meat and education around that as well.

SPEAKER_05 51:05

There's a lot of there's information going on that that our because our models focused on vegetables, we're not looking at that question. But I have colleagues in the States that are looking at um omega-3-6 ratios, um, the benefits uh to growing uh kind of regenerative ranching. Um, and we know that some medically tailored grocery models will include the meats. I'm not sure of many programs that are actually doing regeneratively grown meat per se. I do know one of my colleagues is doing medically tailored meals. She sources all the vegetables, again, only vegetables, um, similar to ours, and that's how they create their meals. But it's a huge area and opportunity.

SPEAKER_02 51:43

Thanks, Stephen. That was fantastic. Um, I'm interested to know a little bit more about the funding model. You said philanthropy had a role there, keen to know what that was. And then in terms of the farmers themselves, does your relationship with um FarmFresh, I think that's that's what it's called, presumably it's got an, you know, they've got a long-term sourcing agreement with this, so farmers know they've got a long-term contract or an off-take agreement. Is that right?

SPEAKER_05 52:06

Great question. So let me start with the latter part. We partner with FarmFresh CU, which is this network of farms. They do all the management and relationship work with the farmers. We've visited some of the farmers, but we're not as engaged in the details. What we understand is that when they partner with a farm, that farm is not just um sourcing for recipe for health, but for their rest of their model. FarmPreshCU does direct to consumer produce boxes. But because we have in our contract said we want to prioritize BIPOC farmers, that has influenced their whole chain because they buy from that farmer now, not just for recipe for health, but for the rest of their supply.

SPEAKER_02 52:43

Sorry, final question. And please don't forget the philanthropy one. I'm really keen to know. Um, do you prescribe what you want the farmers to grow for you?

SPEAKER_05 52:52

Great question. We actually are not prescribing specifics because it when we're only at 10 to 12% of vegetable intake, it doesn't matter. I'm just like, just get and we just grow seasonally and organic and so seasonal. And that's why our behavioral pharmacy helps to kind of bring the gap between, well, I didn't pick this, this rhubarb or this broccoli, what do I do with it to actual consumption? That's to close that gap. In terms of philanthropy, Rockefeller Foundation, they fund some of our work and our health multiplier work. They've worked with the American Heart Association to invest $250 million or a quarter of a billion dollars into the research to demonstrate to the health plans and the actuaries in the health plans why food as medicine should be part of regular care. So that's one huge investment. And we we there's a lot of people that are interested in the space. But we know at the end of the day, and I'll borrow from one of my colleagues, system level change needs system level funding. Philanthropy is can be huge, but it's you want you want to build this into healthcare, into the funding stream to make it long term.

SPEAKER_07 53:59

Hi, Stephen. Um, I just had a quick question about uh uh the relationship. If you could talk a little bit about the science um behind the relationship of um food intolerances in the ag system.

SPEAKER_05 54:11

Can you say more? Food intolerance in the ag system?

SPEAKER_07 54:15

So sorry, uh I'm just noticing that there's a big rise in food intolerances in Australia at least. And I'm just interested if you've seen any science around drivers behind that coming out of our food systems, or is that something different entirely?

SPEAKER_05 54:28

You know, I I I don't have a lot of um, I haven't researched that space. I often hear uh thoughts about gluten and the kind of protein composition. Um, there is a farmer in in um in in the US that grows um wheat differently, and apparently his celiac patients can actually take that uh form of wheat, which is incredible to hear. Um, so I imagine there's some interplay there. I just don't have as much information. I will say we are doing a study with the periodic table of food initiative to look at the food composition of our regeneratively and organically grown vegetables and compare that to a counterfactual, to a to or to conventional. And they're gonna do an omix approach, is they're gonna break down essentially all the different constituents of the food. So we're gonna look at that, we're gonna look at heavy metals, but I think that there's a whole piece on well, what does what does pesticides do, if anything, to modulate your microbiome? I can postulate because the gut microbiome is critical to immune health, and that's where autoimmunity has an impact.

SPEAKER_09 55:32

So we're over there, and there was a hand in here. Can we go there to there, Rose, and then we'll span out. Yeah, we'll get time.

SPEAKER_12 55:39

Hi, Stephen Chen and Anita Pearson. Um, thank you very much for your um very interesting presentation. And what I really enjoyed about it, given my own public health health promotion background, is that you've actually made that link between health and land and food, which is terrific. But I'm also um really found it very helpful because I also do systems thinking and transdisciplinary approaches, that you've actually made all those connections, not only at system level, but also the interface between different systems. And here in Australia, you may or may not be aware, but we're currently going through a policy development process to develop a national food security strategy. Um, there's been a recent series of various co-design workshops around the country. There's been a process of submissions, there are a lot of controversy and debate about who's sitting on the National Food Council because there's a lot of missed opportunities in terms of representation. Yes. And given what's happening in the world at the moment, this is this whole process is also raising considerable debate and discussion around Australia and what does food security actually mean in so many ways. I think myself that a big part of the equation, and I'm mostly speaking to the farming or agriculture sector here, is the valuable contribution of households and communities to food security, to the food system itself. And this was very evident during uh COVID-19 pandemic. I was in Victoria at the time with the various restrictions, and so it's basically we had to look after ourselves and each other because we couldn't rely on the government or big picture to help us or do it for us. Um and I also think not just farmers, but many people uh have there are some deficits or limitations, is a probably a more diplomatic way of saying it. We have a need for more uh cooking and gardening skills in our communities and in our households, and also about food system literacy and food and nutrition literacy, which I think will help that picture that you are you know beautifully describing and putting into practice. Thank you.

SPEAKER_05 57:54

I'll just say that uh gardening is medicine. If I could clone myself or have other team members, we'd be engaging in that. Victory Gardens in the US were a thing. Um, there is a whole culinary medicine piece that I didn't necessarily get into. That's happening with teaching kitchens. My colleague David Eisenberg is leading that work in the in the US. So there are multiple components. I was trying to do that soil to sell piece to show that this is only part of the solution, but it's a beginning point to bring the system together. But we have to add on these other pieces. And mutual support is always going to be needed. Okay.

SPEAKER_09 58:27

So we're going there. And then can we come next to the hand in front there? It's been up all the whole time. Thank you.

SPEAKER_11 58:33

Hi, thank you, Stephen. Um as a local grower myself who grows in soil, do you know of any studies that have been focusing on, because I see you you use the organic and regenerative buzzwords, but um in America especially and now in Australia, you can still use those labels but grow hydroponically. Uh do you know of any studies that are being done or that you know of yourself to suggest that they're sort of inferior to being grown in soil?

SPEAKER_05 59:06

It's a great question. I am not aware, but I do think that is. I've heard from my organic farmer friends and regenerative farmer friends, like, hey, it's all about the soil. Like, you know, and then you hear some folks that are like, well, I'm in the inner city and I'm using water, we have water scarcity, so we're gonna, or or not water scarcity, but we don't have soil. I don't know. I think that's worth looking into. I'd be curious if anyone else does does.

SPEAKER_09 59:27

Thank you.

SPEAKER_10 59:29

Thank you. Thank you for your work and for a wonderful presentation. I wondered if you intend to go down the food labeling route so that people not on your program actually have the opportunity to see when food is grown in regeneratively or in good soils.

SPEAKER_05 59:48

Yeah, you know, I it's an interesting question around labeling. I think you all use HealthStar, is that right? Like a five-point system. I you know, it's interesting. I I haven't I need to think more on that question, right? Um I know that my colleagues in the organic farming space have been frustrated with the USDA definitions and how we kind of how it got structured for what organic is. And so they go beyond organic. Like that's one approach. And then there's a whole issue, well, regenerative and what does that mean? Does that get greenwashed and whatnot? Um I think it's an open question. Um uh because I often hear people talk about consumer-led approaches, and that that's what would be useful to kind of get through all the muck of it all. Um, but I think it's a longer conversation. I I I'd love to hear, you know, how do we how do we how do we wrestle with this question and do it in a in a way that makes sense?

SPEAKER_09 1:00:46

Great. We we uh just so you know, in case you're relying on me to shuffle you out at 1245 for other things, there's a bunch more hands. So I'm gonna suggest we go on for another five minutes. So if you do need to move on, that's understood. We've got we've got a couple of hands up the back for now. See how quickly we can move on.

SPEAKER_01 1:01:02

I've got the mic. Um, quick question. Um, a key part you're doing is you're engaging with health insurance companies and they're willing to pay for these programs. Are you managing to engage them by demonstrating that prevention is cheaper than cure? Or are you managing to engage them by pushing through policy and legislation?

SPEAKER_05 1:01:22

It's both in. So we when Supervisor Chen asked me to come onto this work, she wanted to use a legislative approach because our agencies, our department agencies, you know, I I know my fellow colleagues, they're doctors. We're thinking as doctors do. We don't know anything about food and farming. And so the idea was you need legislative champions to push the agencies that think about it. So that's the policy piece. And so indeed they did. Um, we do work with the health plans in terms of demonstrating impact. And that's part of this investment by Rockefeller. Rather than a single program like mine trying to carry the burden of all the research, although we do have research, we partner with Stanford and UCSF to look at our data. It's important that um we also help close those gaps from a research perspective.

SPEAKER_09 1:02:11

Yeah, go ahead. Thank you.

SPEAKER_06 1:02:12

Thanks very much, Stephen. Um, my name's Sung. I'm a GP or PCP in your parlance in in Kolak, just 20 minutes from here. I I've been working on trying to get a produce prescription research project up locally. Would you say that rather than spending time on that, is the evidence base kind of strong enough for you to be able to persuade policymakers to fund? And would you advise people trying to get into this just to get straight into it and try to set up a program? And I would also be very interested to touch base with people here who are interested in this locally.

SPEAKER_05 1:02:48

Yeah. Yeah. You know, I it's interesting. The state of the the reason that the Rockefeller and American Heart Association invested a quarter of a billion was they saw that there were all of these small studies that were coming up and they're interesting, but they weren't kind of meeting the rigor because you need a lot of funding. You need university-based funding, all of that, to do that type of stuff. So for early pilot stuff, just to get it off the ground, it can be useful. I don't necessarily recommend you have to go be the if you're a practitioner that you have to hold and solve the problem of research and the you can point because there's enough stuff happening now. I do think it's still important to know your own data and to be able to tell your own story. So capturing data versus research, an important distinction, still important to do.

SPEAKER_09 1:03:35

All right. We got two minutes, two more questions, one and two, and and then we can have a little yarn up here afterwards. Go ahead.

SPEAKER_08 1:03:41

Yeah, absolutely love your work, Stephen. And um and it looks like you've got some great momentum, which I imagine has taken a long, long time and been a battle to get there. How do you what are you what do you see the major challenges of scaling this and making it just normal in every country?

SPEAKER_05 1:03:56

You know, it's interesting you asked that question. Uh, Rockefeller, again, I'm I'm mentioning them because they're really leading this work. They just convened a global food as medicine alliance. And you have someone from Australia representing you all, uh, from the Georges Institute, a research institution, Jason Wu. He was kind of representing Australia to talk about what are the eight principles needed to grow this internationally. So I think there's that movement work that is happening that needs to happen.

SPEAKER_09 1:04:27

Last one, we got one minute. This will be this will be it.

SPEAKER_04 1:04:31

Thank you so much, Stephen. That was fantastic and congratulations. Um, my question is sort of two-part but in a similar vein. So, in terms of the general compliance for the patients, how's that? And then after that 12 weeks, is there something put in place for them to receive some continuity and positive momentum moving forward?

SPEAKER_05 1:04:52

I don't have exact data. Um, and I was asked this question earlier in the week when I spoke. If I prescribe recipe for health to you, what is the rate of acceptance of that prescription versus not? Because I only prescribe if you say yes, right? So I don't, I'm not tracking how many people said no, so I don't have that. In terms of adherence, though, once a patient is in, we do know that we just published a paper last year that shows dosage. Patients who meet the 75% threshold of health coaching visits, they get a better health outcome. There's an effect, a threshold effect. Um, we have pay, and then I have anecdotes. We have patients that uh start and they don't continue. But we have patients who start and they don't want to stop, and then they join our peer health at our peer coaching group, and some of them then become actual health coaches. They actually become employed to do this work with their rest of their pay patients, their colleague patients.

SPEAKER_09 1:05:51

Thank you so much, Stephen, for this has been amazing to hear. Please give them a warm hand.