Mayor Mamdani’s N.Y.C. Groceries (NYCG) initiative is underway, with locations announced in East Harlem and the Bronx, and three additional sites planned for Brooklyn, Queens and Staten Island. According to Mamdani, the stores will put affordable “high-quality” groceries within reach of working-class and lower-income New Yorkers.
That is a worthy goal, but affordability alone does not go far enough. If NYCG is going to succeed, it should also address diet-related disease. “High-quality” food has no formal definition, but an evidence-based approach that improves access to fruits, vegetables, legumes, nuts and seeds, while limiting the consumption of excess sodium and refined sugar, could be transformative.
To truly serve the needs of New Yorkers, NYCG should think outside the traditional grocery model and build a fully integrated Food-as-Medicine Health & Grocery Hub, where healthcare dollars help pay for groceries and nutrition education happens within the store.
The food Americans eat is the single largest modifiable driver of the chronic disease epidemic, which costs the country $4.5 trillion annually. In New York, more than 1 in 4 residents have hypertension, an estimated 10% have diabetes, and cardiovascular disease is the leading cause of death. The most economically vulnerable New Yorkers struggle to afford food while also struggling to afford healthcare and suffering from higher-than-average rates of diet-related cardiometabolic disease.
A growing body of research has demonstrated the effectiveness of Food as Medicine (FAM), a model of care sometimes described as “Food is Medicine.” This approach recognizes nutritious food and access to it as essential components of preventing and treating diet-related chronic conditions, including obesity. As clinicians, researchers, and advocates, we have seen those findings borne out in our clinics, studies, and homes.
Questions remain about the economics of city-supported grocery stores, given grocery retail’s famously thin profit margins, past issues with publicly funded grocery ventures, and rising food costs. By formally uniting the issues of hunger and health, however, Mamdani can tap into funding already earmarked for Food as Medicine initiatives, helping address both the financial and health challenges facing the NYCG plan.
For example, New York State has approved the use of the Medicaid 1115 Waiver to pay for nutrition services such as produce prescriptions, medically tailored meals, and nutrition counseling for adult and pediatric patients with chronic conditions, including obesity. Medicare Advantage programs are also increasingly funding Food is Medicine interventions. With nearly 4 million NYC residents currently covered by Medicaid, and around 1.5 million residents over age 65, these are real opportunities to bring healthcare dollars into NYCG stores.
Additionally, around 200,000 veterans live in New York City, and the Department of Veterans Affairs has a Food as Medicine pilot program in which veterans receive a $100 debit card to purchase fresh produce. Outside of healthcare-specific programs, SNAP Double Up Food Bucks allows participants to double the value of their SNAP benefits when they spend them on fresh produce. These existing programs can be integrated into NYCG, improving food access and health outcomes.
In doing so, NYCG can create a paradigm-shifting model, providing a blueprint for how FAM could be embedded within future grocery stores and replicated nationwide.
We imagine one of Mamdani’s proposed locations, dubbed “The Peninsula,” as the model for a Food as Medicine Health & Grocery Hub. This Bronx project, which will include more than 50,000 square feet of community space alongside 20,000 square feet of grocery retail, could become a place where community members learn about healthy cooking and interact with clinicians, as they retrieve produce prescriptions and medically tailored groceries and meals.
The community space could host nutrition and cooking workshops, emphasizing culturally relevant approaches and FAM coupled with dietitian support, which have proven especially effective. Responding to calls for improved nutrition education for physicians, these stores could partner with city hospitals to provide continuing education to clinicians. Weekly grocery store tours led by Food as Medicine-trained physicians — “Shop with a Doc” programs — could strengthen communication and build trust between patients and practitioners.
Shelves stocked with foods sourced from New York farms would provide additional benefits to the local economy, and research shows that prioritizing local procurement within Food as Medicine programs can generate significant economic gains for states and local farmers. An analysis by The Rockefeller Foundation estimates that locally sourced NY FAM programs would drive nearly $30 million to local farms each year, improving the bottom line of around 630 small- or midsize farms. In this way, NYCG would also improve the health and finances of rural communities, extending its benefits to New Yorkers who may never shop in the five stores.
Rather than competing dollar-for-dollar with private grocery stores, these locations could operate through different channels and promote a model that is community-centered, economically beneficial, and nutrition-focused.
Fortunately, there is no reason for the Mamdani administration to do this work alone. Organizations such as The New York State Food as Medicine Coalition know the landscape well and can provide operational and economic guidance. The Rockefeller Foundation invests in FAM programs, and its recently released report detailing the state-level economic benefit of locally sourced Food as Medicine programs could serve as a guide for prioritizing local procurement.
True innovation in grocery requires recognizing that food and health are inseparable. Food choices can drive disease, or they can be powerful medicine for preventing and reversing chronic illness. At a time when Americans struggle to afford both their insurance premiums and their groceries, prioritizing Food as Medicine within the NYCG framework could provide the financial and health support that millions of New Yorkers desperately need.
Mamdani has promised New Yorkers affordable food and improved quality of life. He can deliver both by creating Food-as-Medicine Health & Grocery Hubs that utilize funding already in place and build nutrition education into the food shopping experience.
If New York City gets this right, it won’t simply create another grocery store model. It will show cities across the country how food and healthcare can be successfully integrated into one system to improve human health and long-term economic stability.
Flaxman is communications and advocacy lead at the Cornell Joan Klein Jacobs Center for Precision Nutrition and Health. Loy, a faculty fellow at the Jacobs Center, is director of the Griffin Healthspan and Vitality Center at NYU Langone Health. Mehta is director of the Jacobs Center and a professor of nutritional sciences at Cornell University.