State of the Situation: Food Security in Bolivia

Written by Caitlin Matthews (2016 FLPC Summer Intern, Tufts University M.S../M.A. ’17)

Photograph by flickr user Matthew Straubmuller.

Photograph by flickr user Matthew Straubmuller.

This past summer, as an intern at the Food Law and Policy Clinic (FLPC), I began working on an FLPC project with our client María Teresa Nogales, Executive Director of Fundación Alternativas, a nonprofit organization based in La Paz, Bolivia. Working through email and weekly Skype conversations, we outlined a plan for the Clinic to develop policy briefs linking food insecurity with the issues of food imports, gender inequality, and urban poverty in Bolivia. María Teresa envisioned that the briefs would answer three questions:

  1. What is the connection between the issue and food insecurity?
  2. What is the socioeconomic impact?
  3. What policies exist in other places to address the issue?

The project was a dream match for my skills and interests. I was engrossed in the research, much of which was in Spanish and included reading the Bolivian Constitution and national agricultural policies, digging for data from the Food and Agriculture Organization's Statistics Division and the World Bank's World Development Indicators, reading academic papers regarding food security in Bolivia, and identifying case studies from around the world as potential policy approaches to improve food security. As a dual masters degree candidate in the Agriculture, Food & Environment and Urban & Environmental Policy & Planning programs at Tufts University, I was able to integrate my non-law perspectives on policy, planning, and public health. However, this was also a learning experience in recognizing how comfortable I am with the jargon of my field and how I need to adapt my writing to be accessible to a broader audience.

Fundación Alternativas reportMy research culminated in four recently published policy briefs that explore the links between food insecurity and issues of particular social and political interest in Bolivia - specifically nutrition, global food trade, urban poverty, and gender inequality - and offers recommendations for policies to address food insecurity. Fundación Alternativas will use these briefs in their outreach to elected officials and diverse civil society organizations in order to heighten awareness of the challenge of food security, its connection to other pressing issues in Bolivian society, and potential policy approaches to improve food security.

Working with María Teresa and Fundación Alternativas has been an expansive academic and professional experience, and is one that I hope to continue. I have recently applied for research funding to collaborate on data modeling and spatial analysis to inform policy making and policy implementation to strengthen the food system and food security in the La Paz metropolitan region.

Harvard Law decries Medicaid drug practices, spurs class-action suit in Washington state

Originally published by Boston Business Journal on February 19, 2016. Written by Jessica Bartlett.

Harvard Law School has filed a class action lawsuit against the state of Washington’s Medicaid program, challenging a provision that denies expensive Hepatitis C to many patients enrolled in the program.

The university also has hinted that its Center for Health Law and Policy Innovation may also take legal action against Medicaid insurers in Massachusetts, where restrictions on using expensive hepatitis C drugs are common.

The Washington lawsuit's proposed class of plaintiffs includes Harvard as well as patients who say they were denied hep C medications as mandated by the state's Medicaid program. The Washington State Health Care Authority currently restricts access to certain Hepatitis C drugs, such as Harvoni, to Medicaid members only with severe liver damage.

“Washington is in our view a first step in solving a much bigger national problem,” said Kevin Costello, director of litigation for the Center for Health Law and Policy Innovation at Harvard Law School. “It’s a small piece of a large puzzle. There are plenty of other points, both litigation and policy and regulation-based, that have to be worked on at the same time.”

The hepatitis C drugs, known as direct-acting antiviral medications, have gained notoriety not only because they cure people affected with the disease, but because of their lofty pricing. For example, a course of treatment for Harvoni runs $94,500. Harvoni is made by Gilead Sciences (Nasdaq: GILD).
The lawsuit was filed jointly with Columbia Legal Services and Sirianni Youtz Spoonemore Hamburger. Costello estimates that there are several thousand Washington residents on Medicaid who have been denied access to Hepatitis C drugs.

The lawsuit is the second to be filed nationally against a state Medicaid program, Costello said, noting there is also a lawsuit against Indiana’s Medicaid program. Harvard is not involved with that case.

Harvard said additional legal action may be targeted at local Medicaid insurers, some of whom have restrictions for direct-acting antivirals. Costello said patients enrolled directly through MassHealth have unrestricted access to drugs like Harvoni, however patients covered by managed Medicaid insurers restrict access.

“It’s not OK to MassHealth members — one in fee for service and one in a managed care organization — to have disparate benefits provided to them because of the avenue they receive their benefits. We think that violates the law,” Costello said.

The Harvard Center for Health Law and Policy Innovation, as part of the Massachusetts Viral Hepatitis Coalition, wrote a letter to Massachusetts Attorney General Maura Healey on Jan. 11 requesting she investigate the benefit differences for MassHealth members. Costello said the Center is also investigating other enforcement options.

CHLPI Litigation Manager Quoted in Rhode island Public Radio

Medicaid Reimbursement Map“We really view Washington as a first step in solving a problem in a much broader context," says Costello. "So it’s one small piece of a broader puzzle.”

A February 19, 2016 article published by Rhode Island Public Radio discusses recently filed litigation to challenge the Washington  State Health Care Authority (WHCA) and its restrictions to medications to treat Hepatitis C.

In "Second State Sued Over Hepatitis C Medication Access," reporter Kristin Gourlay interviews CHLPI's litigation director and senior associate director Kevin Costello on the class action lawsuit, filed by CHLPI, and Washington-based Columbia Legal Services and Sirianni Youtz Spoonemore Hamburger.

Read "Second State Sued Over Hepatitis C Medication Access" in full.

 

CHLPI Files Lawsuit Challenging Exclusion of Coverage for Cure to Hepatitis C Virus

On February 16, 2016, the Center for Health Law and Policy Innovation at Harvard Law School, Columbia Legal Services, and Sirianni Youtz Spoonemore Hamburger filed a class action lawsuit against the Washington State Health Care Authority in federal district court in Seattle. The lawsuit challenges WCHA’s policy of rationing Medicaid coverage of prescription drugs that cure infection of the Hepatitis C virus (HCV).

According to the Complaint, WCHA restricts coverage of direct-acting antiviral (DAA) medications like ledipasvir-sofosbuvir (the name brand known as Harvoni®) to only those Medicaid enrollees with severe liver damage, even though the medications result in cure rates approaching 100% for all individuals infected with HCV. The case is B.E. and A.R. v. Teeter, No. 2:16-cv-00227.

The lawsuit alleges that limiting treatment to Medicaid enrollees whose health is already badly damaged is impermissible under federal law. Forcing Medicaid enrollees to wait until their health worsens violates clinical guidelines of the American Association for the Study of Liver Diseases (AASLD). “[C]linicians should treat HCV-infected patients with antiviral therapy with the goal of achieving an SVR [sustained virologic response or cure], preferably early in the course of their chronic HCV infection before the development of severe liver disease and other complications.”

The lawsuit asks that the Washington State Health Care Authority be required to provide treatment for HCV that meets the AASLD accepted standard of care.

Read the press release on the lawsuit here.

Campesinas Share Their Stories with the Harvard Community

Written by Lisa Glickstein, JD '18 and Secretary-Treasurer of Harvard Food Law Society

Originally posted on the Harvard Food Law Society blog

Who worked to produce your lunch?

On February 9, 2016, three members of the Alianza Nacional de Campesinas (National Alliance of Female Farmworkers) came to Harvard Law School to speak about the injustices that female farmworkers face on a regular basis.The Alianza works to empower and educate female farmworkers about their rights, creating a network of women and organizations that support their interests. Dolores Bustamante, Beatriz Gatica, and Hormis Bedolla each shared poignant stories that illustrate the difficult realities that female farmworkers tolerate while working in agricultural operations in the United States.

Many of these female farmworkers are undocumented, and the constant threat of deportationCampesinas at Harvard often prevents them from speaking out when their rights are violated. They described how female farmworkers often experience sexual assault and domestic violence, both at work and at home. However, women rarely raise these issues. Oftentimes, female farmworkers are highly dependent on both their spouses and their workplace for housing and financial support, and speaking out may compromise their job and income security.

Farm labor is grueling work. While in the field, farmworkers wear large sweatshirts and bandanas to protect themselves from the harmful pesticides used in crop production. In spite of these inherent dangers, they often receive below the minimum wage. The Alianza members explained that they often receive payment through an intermediary, who may take a large cut of their wage. Agricultural workers are exempt from the Fair Labor Standards Act. Accordingly, they are not entitled to overtime pay, vacation, or holidays. They are not allowed to unionize. Given this gross imbalance in bargaining power between farmworkers and their employers, it is difficult for them to object to the frequent labor abuses that they experience.

Nor does law enforcement provide a viable outlet for their complaints. Dolores spoke of a personal encounter with the police, who wrongfully detained her without cause and threatened deportation. She was released only after the Alianza stepped in on her behalf and threatened to expose the police department’s wrongful behavior.

The women shared a simple request with the classroom full of law students: to be afforded the basic human rights of fair compensation, personal health & safety, and freedom from fear of deportation.

CHLPI Files Supreme Court Amicus Brief Defending Employees Access to No Cost Preventive Health Care Services

On February 15, 2016 the Harvard Law School Center for Health Law and Policy Innovation (CHLPI) spearheaded the filing of an amicus brief to the U.S. Supreme Court in Zubik v. Burwell, the next major challenge to the Affordable Care Act (ACA). The brief requests that the Court affirm multiple Courts of Appeals’ decisions upholding the federal Government’s choice to maintain access to no cost contraceptive services in health plans sponsored by employers, including religious non-profit employers. CHLPI and the other signatories submitted this brief to advocate for employees’ right to make their own medical decisions, without interference from their employers, and to protect our health care system’s ability to effectively respond to public health crises.

Twenty-six non-profit organizations signed onto the brief, including many health care access and HIV advocacy organizations. The list of organizations includes:

  • AIDS Action Committee of Massachusetts, Inc.
  • AIDS Alabama
  • AIDS Foundation Chicago
  • AIDS Law Project of Pennsylvania
  • AIDS Project Los Angeles
  • AIDS Research Consortium of Atlanta
  • APLA Health & Wellness
  • Cascade AIDS Project
  • Community Catalyst, Inc.
  • Eastern Bank Corporation
  • The Empowerment Program
  • Hepatitis Education Project
  • HIV Prevention Justice Alliance
  • John Snow, Inc.
  • Latino Commission on AIDS and the Hispanic Health Network
  • Legacy Community Health
  • MassEquality
  • Minnesota AIDS Project
  • NO/AIDS Task Force
  • North Carolina AIDS Action Network
  • Positive Women’s Network–USA
  • Project Inform
  • SisterLove, Inc.
  • Southern AIDS Coalition
  • Southern HIV/AIDS Strategy Initiative at Duke University School of Law
  • Rhode Island Public Health Institute
  • Urban Coalition for HIV/AIDS Prevention Services

“Preventing religious employers from making health care access decisions for their employees is critical to ensuring that the ACA will carry out its intended goals and that the health of employees remains our top concern,” said Robert Greenwald, Clinical Professor of Law and Faculty Director of CHLPI. “This is particularly important as we work to create a health system that focuses on prevention and early intervention health care that both improves public health and health outcomes and reduces costs.”

Read the full press release about CHLPI's amicus brief for Zubik v Burwell.
Read the amicus brief.
Read Harvard Law School's article "Harvard Law Clinic Files Amicus Brief Defending Employees’ Access to No Cost Preventive Health Care"

FLPC releases short film on expiration dates and food waste

The Harvard Food Law and Policy Clinic (FLPC), in partnership with Racing Horse Productions, today released the short film EXPIRED? Food Waste in America in the Los Angeles Times. EXPIRED explores how misleading date labels on food products contribute to food waste in America. Every year, 40% of the food produced in the United States goes uneaten, leading to 160 billion pounds of wasted food in our landfills.

As FLPC explained in its 2013 report, The Dating Game: How Confusing Date Labels Lead to Food Waste in America, the date labels on food products are a major cause of this unnecessary waste. Because the federal government has no standardized regulations for these dates, labeling practices are governed by inconsistent state regulations and industry discretion. As a result, the date labels consumers see on foods –“use by,” “best before,” “sell by”—are misleading. Most consumers believe that date labels are safety indicators, when in fact, the labels are meant to indicate when food will be at its peak taste. Although there is no uniform regime for determining these dates and they are not related to safety, states often regulate the sale or donation of food items after the date listed on the label. This confusing system leads manufacturers, retailers, and consumers to discard food that is perfectly safe to sell or eat.

Through the production of EXPIRED, FLPC and Racing Horse Productions sought to explore the information presented in The Dating Game in a new and more accessible format. FLPC students and staff worked with professional filmmakers Rebecca Richman Cohen of Racing Horse Productions and Nathaniel Hansen to plan, edit, and produce the film. FLPC Director Emily Broad Leib says “FLPC students worked on this film as the media advocacy component of a greater project conducting legal and policy research, educating consumers and policymakers, and pushing for policy change to reduce the waste of healthy, wholesome foods in the United States.  By working with Racing Horse Productions, together we were able to empower students to tell this compelling story in a strategic and sophisticated way, in order to effectively sway public opinion and affect policy change.”

The film focuses on Montana’s date labeling law, which requires all milk to be labeled with a sell-by date no later than twelve days after pasteurization and prohibits the sale or donation of milk after passage of that date. Montana’s restrictive date labeling law for milk has resulted in thousands of gallons of milk being thrown away and has led to higher milk prices in the state. Unfortunately, Montana’s law is just one example of the many state date labeling laws that cause confusion and lead to food waste. Broad Leib says “Consumers suffer because milk in Montana costs more than neighboring states. But while this is the most restrictive state law in the country for milk, it’s far from the only state law imposing date label requirements on manufacturers, distributors, and retailers. Our research has shown that 41 states require date labels on at least certain food products, and 20 states then restrict or ban the sale or donation of foods after that date. This patchwork of state laws and regulations creates customer confusion, limits retailers’ ability to sell or donate safe, wholesome food, and causes unnecessary food waste. It’s a challenge that requires creative problem solving to address.”

FLPC is calling for the creation of a federal law that would standardize the date labels allowed on food products in order to clearly distinguish between quality and safety dates. This can reduce consumer confusion, simplify regulatory compliance, and cut food waste across the supply chain and in consumers’ homes. This law should also bar states from prohibiting sale or donation of food after its quality date. With the release of this film, FLPC aims to raise awareness about the consequences of confusing and non-science-based date labeling, and about the impact that a uniform labeling standard could have on reducing food waste. “We believe EXPIRED will be a powerful catalyst for change by offering a visual and visceral understanding of the problem, raising awareness about ways to combat it, and engaging key stakeholders in the issue,” adds Richman Cohen.

For more information and to view the film, please visit www.notreallyexpired.com.

Food Sovereignty in Navajo Nation

By Jevhon Rivers, JD '17, Harvard Law School

20160107_145144I spent two weeks in the Navajo Nation as a Continuing Clinical student for the Food Law and Policy Clinic. I had been working on food sovereignty research for a partner in the area during the Fall, but could not comprehend the true depth of the challenges facing the Navajo Nation nor the passion and knowledge of its food advocates until I had the opportunity to visit it myself. During my time there, I was able to see advocates and government representatives working together to solve the complex food issues on the Navajo Nation, while also getting to see the work organizations are already doing, specifically to address chronic illness and increase food access.

In Window Rock, Arizona, the seat of government for the Navajo Nation Council, I had the opportunity to join a coalition of diverse advocates working toward food sovereignty. Indeed, the Nation seems to be on the precipice of real reform. I attended a committee meeting and a work session of the Health, Education and Human Services Committee (HEHSC) where representatives used the Good Laws, Good Food toolkit, created by FLPC and partners, as a jumping off point. Through these sessions and later meetings with other food advocates and coalition partners, I met key officials that lent insight into the work being done in education, food assistance, and agriculture among others.

During my stay, I was hosted by a partner organization, Community Outreach Patient Empowerment (COPE), a sister organization of Partners in Health (PIH) that works with the Navajo Nation to address chronic illness through education and outreach. Sonlatsa Jim-Martin, the COPE REACH Coalition Coordinator, invited me to participate in a wealth of events and experiences throughout my stay. I was able to get involved in a number of different projects with which COPE is affiliated. I spent one weekend with the Navajo Community Health Outreach (NCHO) Youth Leadership, working with young leaders who serve as public health champions in their communities. Not only did I have the privilege of learning about the role of food in Navajo traditions and culture but I got to witness the variety of public health projects they were creating, such as a campaign to share traditional wisdom on food in local chapter houses.

Later in my stay, I went with the COPE team to a clinic on the opposite end of the reservation to check in with the FVRx program at Monument Valley Clinic. FVRx, or the Fruit and Vegetable Prescription Program, was developed by Wholesome Wave, and enables community healthcare workers to provide health and nutrition counseling coupled with prescriptions for fruits and vegetables that can be redeemed at local stores. Along with store owners and community members, the COPE team planned not only how they would recruit eligible mothers and children, but how they could adjust the education component and vendor partners to best serve their patients. On the way, we stopped at several food vendors as part of COPE’s Healthy Stores Initiative, to give them equipment to facilitate the sale of produce and provide them strategies to make the most of selling healthy food.

20160114_134252My time in the Navajo Nation not only provided an enriching complement to the research I had completed in the Fall, but gave me greater insight into the inspiring power of food to bring people together in inspiring and unexpected ways.