From Harvest to Health: A Systems-Based Evaluation of FarmsSHARE's Impact on Nutrition in North Carolina.

backgroundPersistent food insecurity and diet-related chronic disease in North Carolina underscore the need for systems-based approaches in nutrition and dietetics. Small- and medium-scale farms face barriers to consistent markets, while food-insecure households encounter limited access to fresh, culturally relevant foods. Programs that integrate local food production with community-based distribution can simultaneously address agricultural, nutrition and health system challenges, while fostering community resilience through new connections and partnerships.

objectiveThis study evaluates the 2024 Local Food Purchasing Agreement (LFPA)-funded FarmsSHARE program through a systems-based lens, examining cross-level impacts on farm viability, organizational capacity, food and nutrition security and dietary health outcomes.

methodsA mixed-methods evaluation engaged four stakeholder groups, farmers, food hubs, community-based organizations (CBOs) and program recipients, using statewide surveys (n = 322) and 14 focus groups (n = 105). The evaluation was guided by the High Level Panel of Experts (HLPE) conceptual framework for food systems and the Socio-Ecological Model to capture interactions across supply chains, food environments, food and nutrition security and perceived dietary health outcomes. Quantitative data were analyzed using descriptive statistics and ANOVA, while qualitative transcripts were inductively coded and thematically analyzed to identify emergent system-level outcomes.

resultsWithin the 2024 LFPA-funded FarmsSHARE season, it generated multi-level impacts: (1) increased farm revenue and market stability, including $2.95 million in direct payments to 312 small- and mid-size farms; (2) strengthened organizational infrastructure, with food hubs and CBOs expanding staffing, cold storage and distribution capacity; (3) improved food access and utilization, with 92% of recipients reporting increased access to healthy foods and 95% using all or most of the items provided; and (4) measurable health benefits, including enhanced dietary quality and improved management of chronic conditions such as diabetes and hypertension. Additionally, FarmsSHARE facilitated new community partnerships and cross-sector connections, supporting a more resilient, community-centred approach to health and food security.

conclusionThe evaluation demonstrates that systems-based, multi-level interventions can strengthen local food systems while enhancing nutrition security and supporting perceived improvements in dietary quality and health outcomes among participants. These findings highlight local food as a critical component of food and nutrition security and suggest the need for further research examining objective health indicators, including clinical biomarkers. Registered Dietitian Nutritionists (RDNs) play a critical role as systems-level practitioners, bridging agriculture, community and health systems to design, implement and sustain complex interventions. Scaling and sustaining similar programs require cross-sector collaboration, stable funding mechanisms and integration of local food initiatives into broader health and policy frameworks.