Estimating the climate impacts of procurement for food is medicine programs: a mini review of carbon accounting tools

Food is Medicine (FIM), an emerging area of healthcare focused on healthy food provisioning, is rapidly expanding, but its environmental implications remain uncertain. Some FIM initiatives incorporate procurement preferences (e.g., practice-verified “soil health” approaches), yet the prevalence and degree of such sourcing across produce prescription programs is not well established or required. Accordingly, this mini-review uses a previously defined evaluation framework to analyze two widely used on-farm carbon accounting tools, Cool Farm Tool and COMET-Farm, for their utility in estimating on-farm emissions and soil organic carbon (SOC) outcomes in FIM procurement contexts where alternative production practices (i.e., organic, regenerative and/or polyculture) are explicitly used. We find that both have significant limitations for evaluating climate impacts of alternative procurement strategies utilized by FIM programs. Cool Farm Tool relies on IPCC Tier 1 methods to estimate GHG emissions and SOC at the crop level. COMET-Farm has a more comprehensive approach and relies on IPCC Tier 1–3 methods to estimate emissions and SOC at the farm-level. Both tools are limited in crop coverage and ability to accurately represent carbon sequestration in alternative management systems. Presently, these tools can be used for screening purposes in specific contexts in conjunction with additional measurement. Moving forward, improving the accuracy of both tools would require extensive farm-level data collection on fruit and vegetable production and the inclusion of alternative production strategies. Advancing these tools is essential for guiding FIM procurement decisions toward more climate-resilient food systems to achieve SDG 2 and 13.