National Institutes of Health will study “Food is Medicine”

Written by Hanh Nguyen, Whole Person Care Project Assistant. 

When the Committee on Appropriations recently passed H.R. 6557, The Department of Defense and Labor, Health and Human Services, and Education Appropriations Act for 2019, they also submitted a report accompanying the bill that encouraged the Office of Director of the NIH to work with Institutions and Centers, including NIDDK, NHLBI, NIA, and NICHD, to report on research that has been conducted on Food is Medicine related topics. This may include “medically tailored meals, meal nutrition therapy, produce prescription programs, the role of proper nutrition in aging, and the role of proper nutrition in reproductive health”.

The report also draws attention to the access challenges and out-of-pocket costs of prescribed medical diets. The Committee encouraged the Center for Medicaid and Medicare Services to work proactively with stakeholder communities to identify and address improper barriers to nutritious food access.

CHLPI is excited to see the language of Food is Medicine (FIM) used among policymakers. We are hopeful that a focus on nutrition research will improve our health care delivery system.

There is a growing body of research that demonstrates the impressive results of FIM interventions in improving health outcomes, increasing patient satisfaction in health care, and reducing health costs. In a recent congressional briefing, it was reported that patients who received home-delivered medically tailored meals showed a 16% net reduction in monthly healthcare spendings. Likewise, a new study from Project Angel Heart, a non-profit food and nutrition program serving individuals living with life-threatening illnesses in Colorado, reported that the provision of medically tailored meals resulted in a 13% drop in hospital admissions and 24% overall cost reduction for patients with diabetes, chronic obstructive pulmonary disease, and congestive heart failure.

Despite such results, there is still not a federal funding stream dedicated to medically tailored food and nutrition within healthcare, leaving those who chronically ill, too sick to shop and cook for themselves, or too poor to afford nutritious food at risk for life-threatening conditions that are preventable with proper nutrition.

 We believe that a critical analysis of existing FIM research will set the stage for future innovative policies that will increase access to medically tailored meals. Check out our FIM State Plan to learn more about how CHLPI is working to increase access to FIM interventions in the Commonwealth!


Health Groups Upgrade R.I. Hepatitis C Medicaid Access to ‘A-’

Originally published by the Providence News Journal on October 29, 2018. Written by Rob Borkowski.

The R.I. Executive Office of Health and Human Services removed all restrictions on curative hepatitis C treatments for its Medicaid patients on July 12, a move that the National Viral Hepatitis Roundtable and the Center for Health and Law Policy Innovation at Harvard Law School took note of in upgrading the state’s report card for the Hepatitis C: The State of Medicaid Access project from a “D-” to an “A-”.

Rhode Island’s decision improved access to the treatments for Medicaid patients in both its Fee-for-Service and Managed Care Organization Medicaid programs. Previously, the state restrictions on access to hepatitis C treatments were not in line with federal medical necessity requirements for Medicaid.

But the state worked in conjunction with the Center for Health and Law Policy Innovation, the Rhode Island Center for Justice and other community partners to make the policy change.

“We commend Rhode Island for expanding access to hepatitis C medications for all Medicaid beneficiaries, ensuring that more Rhode Islanders can receive curative treatments. CHLPI encourages other states to follow in Rhode Island’s footsteps and remove their discriminatory restrictions,” said Robert Greenwald, clinical professor of law at Harvard Law School and the director of CHLPI.

Rhode Island’s Fee-For-Service program previously required hepatitis C patients to demonstrate severe liver damage (a fibrosis score of F3 or greater), undergo screening and concurrent alcohol and substance use counseling for beneficiaries actively using, and obtain a prescription from a specialist that is approved by the R.I. Executive Office of Health and Human Services. With these restrictions in place, very few patients diagnosed with hepatitis C had access to treatment. Each year, it is estimated that only 250 Rhode Islanders who are Medicaid beneficiaries receive access to curative hepatitis C medications.

“After years of strong advocacy efforts in Rhode Island, all Medicaid patients diagnosed with hepatitis C can now receive access to treatment without restrictions. We continue to encourage all Medicaid patients at risk to undergo screening and learn about available treatment options,” said Tina Broder, interim executive director of the National Viral Hepatitis Roundtable.


When Does the ‘Affordable’ in the Affordable Care Act Kick In?

Originally published by The Hill on October 14, 2018. Written by By Merrill Matthews, Opinion Contributor. Merrill Matthews is a resident scholar with the Institute for Policy Innovation in Dallas, Texas.

It’s a good thing Democrats made health insurance “affordable” when they passed the Patient Protection and Affordable Care Act in 2010. I’d hate to see how much health insurance would cost if it were expensive.

The Kaiser Family Foundation just released its annual survey of employer-sponsored coverage, finding that the average premium for family coverage increased 5 percent to $19,616.

To put that in perspective, the real median household income in 2017 was $61,372. Thus family health coverage costs nearly a third of the median family’s income.

But citing the average family premium of nearly $20,000, as high as that is, can be misleading. A small employer, especially a one with older-than-average employees, likely blew through $20,000 a few years ago. The premium for a couple in their 50s with a teenager can easily run $25,000. Bump that up by $4,000 or more for each additional child.

However, those outrageously high premiums would be even higher if employers and health insurers hadn’t taken a number of steps to contain the cost explosion by adjusting benefits and exposing employees to significantly higher out-of-pocket costs.

The Kaiser survey points out that since 2008, annual deductibles for covered workers have increased 212 percent—eight times the rate of inflation. And to think Democrats used to call high deductible coverage “junk insurance.” Yet, under ObamaCare deductibles have exploded.

Insurers are also taking steps to increase out-of-pocket spending in less-noticeable ways. For example, in years past insurers charged one copay for a generic drug, say $10, and a slightly higher copay for a brand name drug, say $25.

Then insurers moved to three copay tiers or more. The generic might still require a $10 copay, while some brand name drug copays could run between $25 and $250.

In addition, some insurers now require co-insurance of 20 percent to 40 percent of a drug’s cost for some of the newest and most expensive drugs. If a drug costs $5,000 a month—and some cancer drugs cost that much or more—40 percent co-insurance could cost the patient several thousand dollars a month. And that comes on top of other health care-related expenses and premium costs.

Imposing such high co-insurance rates on specific drugs has raised concerns that insurers were trying to discourage some of the sickest patients from enrolling in their plans. As Kaiser Health News noted a few years ago:

  • In 2016, Harvard Law School’s Center for Health Law and Policy Innovation filed complaints with the U.S. Department of Health and Human Services’ Office for Civil Rights alleging that health plans “offered by seven insurers in eight states are discriminatory because they don’t cover drugs that are essential to the treatment of HIV or require high out-of-pocket spending by patients for covered drugs.”
  • Consulting company Avalere Health found that several insurers’ silver plans had been adversely targeting some of the sickest populations with higher drug costs. “An analysis found that in the case of five classes of drugs that treat cancer, HIV and multiple sclerosis, fewer silver plans in 2016 placed all the drugs in the class in the top tier with the highest cost sharing or charged patients more than 40 percent of the cost for each drug in the class.” Pulling some of the most expensive drugs from the top tier was likely due to protests and threats of legal action. 

To be fair, insurers and employers felt they had to take steps in order to control their costs, otherwise premiums would likely have been even higher than they are.

Other factors are also playing a role in the premium increases. Hospital systems were consolidating prior to ObamaCare, but the ACA put that trend on steroids, enabling hospitals to demand higher reimbursements from insurers.

Consulting firm Kaufman Hall reported in January there were 115 hospital and health system mergers and acquisitions in 2017, up 13 percent from 2016, and the largest number in recent history. For comparison, there were 50 hospital M&A transitions in 2009, the year before ObamaCare passed.

Unfortunately, options for containing premium increases and coverage reductions are limited. The Trump administration is trying to provide as much insurer and state flexibility as possible under ObamaCare, but it’s unclear yet as to how much those efforts can achieve.

And there’s a new proposal, the Health Care Choices Proposal, backed by a number of health policy analysts. It seeks to block grant current federal health care spending on Medicaid and ObamaCare to the states along with some regulatory reductions.

Since Washington has done such a terrible job trying to make health insurance affordable, maybe it’s time to give the states a chance. How much worse could they do?


Should We Just Ban “Best By” Labels on Food?

Originally published by Modern Farmer on October 12, 2018. Written by 

Food labels, as we’ve written about before, are awful: they can be misleading, outright lies, not include enough information, or, in the case of one particular label, encourage bad habits.

Tesco, one of the UK’s biggest supermarket chains, announced this week that it will remove “best by” date labels from 116 fruit and vegetable items. The move builds on a smaller reduction in the label earlier this year. So why are those labels bad?

The “best by” label, along with its siblings “best before” and “best if used by,” are not federally regulated in any way; they are not only not required, but there aren’t even any rules about how to determine which product gets which date. (It’s sometimes done by anecdotal evidence, sometimes by lab tests, more often by just following other labels and assuming that, say, the best time to drink milk is earlier than two weeks after it was processed.)


But over the past few years, resistance to the “best by” label has grown. A 2016 survey from the Harvard Food Law and Policy Clinic found that 84 percent of respondents occasionally throw away food that’s past its labeled date, and a third of respondents “usually” or “always” do. This is a significant issue because that food isn’t actually bad; the “best by” date is not the same as a spoilage date. The “best by” label is, unexpectedly, a major contributor to food waste, and food waste is so rampant in the US that an estimated 40 percent of the entire country’s food never makes it to the plate.


Tesco’s own research indicated that 69 percent of respondents supported removing the “best by” label, with more than half stating that they believed it would reduce food waste. This isn’t a trick to get you to buy spoiled food; you can tell if a tomato is rotten, or about to be rotten, in a way that’s much more precise than a stamped generic label. It’s a way to discourage people from walking past food that’s perfectly good.


How Policy Could Impact Food Waste (Part Three)

Originally published by Waste 360 on October 11, 2018. Written by Arlene Karidis.

In a three-part series this week, Waste360 takes a look at the main issues around food waste and explores what’s going on at the state and federal levels. 

Forty percent of food in the U.S. is thrown out every year, contributing to economic, environmental and social problems that have catalyzed a movement to push for federal policies. In September 2015, the U.S. Environmental Protection Agency (EPA) and the U.S. Department of Agriculture (USDA) established a national goal to cut food waste in half by 2030. Shortly after, the Federal Food Recovery Act was introduced into the Farm Bill, the nation’s first comprehensive proposed law around food waste.

The act’s recommendations, which include food date labeling as well as money for food waste prevention research and for innovations, prompted a lot of back-and-forth negotiations. Finally, in June 2018, the Senate and House approved different versions of the Farm Bill, with very different provisions for the Food Recovery Act, and is now working to produce a compromise bill that has yet to pass both chambers.

Meanwhile, Harvard Law School and Food Law Policy Clinic (FLPC), which helped shape the Food Recovery Act language, continues to push for public policy. FLPC and Rethink Food Waste through Economics and Data (ReFED) are working together on one of policy advocates’ greatest priorities: to get standard date labels. For now, they are working with industry on a voluntary standard label.

“We are focusing on this at a federal level because no standardized date labels creates confusion and is responsible for 20 percent of consumer food waste,” says Chris Hunt, ReFED communications director.

Their work with the Food Marketing Institute and Grocery Manufacturers Association recently led to a voluntary standard of “use by” and “best if used by.” The focus now is on trying to get the standards implemented on a larger scale.

“We are seeing momentum. But the biggest challenges are consumers understanding the labels and lack of federal regulation,” says Emily Broad Leib, director of the Harvard Law School Food Law and Policy Clinic.

Policy advocates are also working collaboratively to strengthen protections for those who donate surplus food. Current federal law, the Bill Emerson Good Samaritan Act, protects businesses that donate to nonprofits, but the focus now is on establishing protections for making direct donations to individuals.

There was plenty more in the proposed Food Recovery Act, and despite the 2014 Farm Bill expiring on September 30, policy advocates hope the initial work will lead to food waste law being incorporated in the 2018 Farm Bill.

Food conservation has recently received a fair amount of attention, at least in the Senate version, notes Nicole Civita, sustainable food systems specialist at University of Colorado, Boulder.

“The House merely included a provision to create a Food Loss and Waste Liaison in the USDA to coordinate federal programs to measure and reduce food waste,” she says.

“The Senate placed greater emphasis on food waste by both calling for a comprehensive study of food waste and directing financial resources toward interventions … focusing on funding to improve storage life of specialty crops,” adds Civita. “It would retool a program around donation of dairy products, establish a local agriculture market program that could make grants to programs that promote business opportunities and marketing strategies to reduce on-farm food waste [among areas such as promoting programs and research around biogas].”

Still, she says, “While this may seem like an impressive array of programs, their scope is tiny both compared to the Farm Bill as a whole and to the size and complexity of the food waste problem itself. Ordinarily, I might applaud progress on this issue at any scale, but given that food waste is a major driver of the climate crisis, I fear that these efforts are too little to support rapid development and deployment of solutions.” 

The federal government has an important role in the continued effort to implement combined solutions, believe policy folks.

The EPA is exploring its potential role through efforts like facilitating regional coalitions to work on solutions and improving data. The two focuses can work together, according to Kathleen Salyer of EPA.

“Data shows where opportunities are for partnerships to prevent and reduce food waste,” she said earlier this year at a Food Waste Summit hosted by FLPC and ReFED.

USDA Secretary Sonny Perdue stated in May that he would prioritize food waste and work collaboratively with stakeholders from farm to fork.

“Secretary Perdue wants to reach out more aggressively to other federal agencies to develop a systematic way across the federal government to address issues,” said Elise Golan of USDA during the Food Waste Summit.


How Policy Could Impact Food Waste (Part Two)

Originally published by Waste 360 on October 10, 2018. Written by Arlene Karidis.

In a three-part series this week, Waste360 takes a look at the main issues around food waste and explores what’s going on at the state and federal levels. 

This past legislative session, 91 pieces of food waste law passed at the state level, mainly around date labels and food donation. With this activity comes both goods news and concerns.

“When the federal government has not made laws that pre-empt state action, lower levels of government can make their own laws,” says Nicole Civita, sustainable food systems specialist at University of Colorado, Boulder. “This allows state and local governments to function as policy laboratories, innovating legal and regulatory mechanisms to address problems like food waste. The downside is that progress across the country can be uneven, and businesses that operate across jurisdictional boundaries must decipher and contend with differing compliance requirements. The patchwork nature of protections, incentives and bans can make it difficult for enterprises to scale up programs that reduce food waste.”

Among the positives is states are offering tax incentives to donate food, particularly targeted to farmers, and some are providing additional protection to donors beyond the federal Bill Emerson Good Samaritan Act. In the past few years, Virginia, West Virginia, Maryland and New York passed laws to incentivize farmers to claim tax credit if they donate food.

While the federal law protects donors who give food to nonprofits, a few states have expanded protections to be able to donate to individuals. For example, school districts in Texas can see that food is distributed to students and families.

“This has a huge on-the-ground impact because it’s saving time and money and still getting food to whoever needs it,” says Emily Broad Leib, director of Harvard Law School Food Law and Policy Clinic. “We’ve also seen states passing or considering food waste diversion laws, restricting what businesses can landfill. Massachusetts, Vermont, other New England states and California have bans,” she adds.

The biggest movement has been around date labels, with many states wanting two standard labels: “best if used by” for quality and “used by” for safety. This area has been problematic. For one, exactly what the label means is proving confusing to consumers. Adding to the gray area is that states implement different language and different restrictions. Policy experts believe unclear language is driving people to toss good food.

Exemplifying the inconsistency piece of the puzzle, Chris Hunt, communications director of Rethink Food Waste through Economics and Data (ReFED), says, “New York State has no food date label requirements, but across the border in Vermont, there is a date label for shell fish. If you go across the next border into New Hampshire, there is labeling for cream and prepackaged sandwiches, so all these labels are arbitrary.”  

Montana has strict date labels, at least on milk, which is “sell by” 12 days after pasteurization. “That’s misleading, as the milk hasn’t neared the end of its shelf life, and the language is different from what we learned is most useful for consumers,” says Broad Leib. Her clinic and its partners confirmed that “best if used by” is most clear as a quality indicator, while “sell by” may sound like a safety issue.

California passed legislation in 2017 to encourage (not mandate) industry to use two standard date labels: “best if used by” for quality and “use by or freeze by” for safety. It discourages sell by dates.

“We initially introduced a requirement that all food labels be standardized in California. The industry killed it but agreed to a voluntary standard. This, in our mind, was a big deal. They committed in front of a legislative body, and I think that was what legislators found compelling,” says Nick Lapis, director of advocacy for Californians Against Waste, the nonprofit that co-sponsored the bill.

“By putting specific terms in the statute and telling the California Department of Food and Agriculture to promote adoption of those terms, we have our foot in the door to codify and mandate law if by chance the voluntary initiative would fall apart,” says Lapis.

He thinks California’s most monumental policy impacting food waste is SB 1383 to deal with especially potent climate pollutants.

SB 1383 sets the goal of a 75 percent reduction in organics disposal by 2025 from 2014 levels and mandates that 20 percent of food currently disposed be used for human consumption by 2025.

Large food waste generators will be required to donate, as well as prevent food waste.

“It will be the first-of-its-kind legislation requiring edible food to be donated or excess to be prevented in the first place. Traditionally, we’ve focused primarily on recycling organics, but now we are putting our money where our mouth is when it comes to the waste hierarchy, with prevention at the top,” says Lapis.

To see what different states are doing around food waste, check out this ReFED tool.


Trump Administration Says It’s Ending ACA ‘Sabotage,’ Experts Say It Comes at Great Risk to Patients

Originally published by Healio on October 11, 2018. Written by Janel Miller.

The average premium for the second lowest cost silver health insurance plans—the one used to determine final premium tax credits—will drop by a “historical” 1.5% for the first-time since the implementation of the federally-facilitated exchange in 2014, according to CMS.

However, experts told Healio Family Medicine that the agency’s actions put profit over patients and puts the well-being of many Americans at risk.

CMS claims

The average change in premium costs may not seem like a lot but is significant when put into historical context, Seema Verma, CMS administrator, said in a conference call with reporters.

“This is a very positive change from the double-digit increases we have seen over the past 2 years,” she said, noting that some states had seen increases of 200% and higher. The change in premiums was just one of the health insurance-related accomplishments under the Trump administration she lauded during the call.

According to Verma, states will soon be able to use waivers to increase their flexibility in sustaining their insurance markets. In addition, for the first time in several years, there will be an increase in insurance providers on the federal health insurance exchange market, she said. 

“While some have been accusing [the Trump administration] of sabotage, the reality is we have been doing everything we can to mitigate the damage caused by Obamacare,” Verma said.

Experts weigh in

Arthur Caplan, PhD, founding head of medical ethics at New York University School of Medicine, and Robert Greenwald, JD, faculty director, Center for Health Law and Policy Innovation at Harvard Law School said in interviews CMS should not be patting itself on the back.

“The idea that the Trump administration is trying to save patients is ludicrous,” Caplan said in an interview. “It has permitted lousy cheap coverage, cheap, almost worthless policies to be sold,”  adding that is the “real reason why” CMS can make an announcement like this one.  

“Putting this pig in a dress by claiming they’re helping people doesn’t make what they’re really trying to do—make the Affordable Care Act a footnote in history — go away. They’re putting money over people,” Caplan added.

“In no way does the Trump administration deserve credit for the state of the marketplace,” Greenwald agreed. “They have done everything in their power to destabilize it.” According to Greenwald, states and insurance companies positively balanced the Trump administration’s actions by funding outreach and navigation efforts to promote the marketplace, adopting their own individual mandates to assure that there is diversity among marketplace applicants, passing laws that banned or limited the introduction of “junk” insurance plans, introducing a reinsurance system that results in lower premiums in their marketplaces, and allocating premium rate increases into silver-level plan premiums only.  Greenwald added it is not too late for clinicians and others to make their thoughts about health insurance known. “If the American people want to see a strong marketplace this year, and the years ahead, they need to voice their opposition to efforts to repeal the Affordable Care Act and the health insurance marketplace,” he told Healio Family Medicine.


How Policy Could Impact Food Waste (Part One)

Originally published by Waste 360 on October 9, 2018. Written by Arlene Karidis.

Sixty-three million tons of food is wasted in the U.S. every year, a staggering volume that exacerbates multiple issues within the food system. It translates to huge losses along the supply chain. It wastes water and fertilizer. Then, there are environmental concerns, as rotting organics pile on landfills and release methane into the air.  

On the flip side, focused efforts to reduce food waste create jobs, provide opportunity to make compost and energy and could help feed the 40 million hungry people in the U.S., according to the United States Department of Agriculture (USDA). The problems and opportunities around food waste are why organizations like Harvard Law School Food Law and Policy Clinic and nonprofit Rethink Food Waste through Economics and Data (ReFED) are pushing for policy around this issue.

ReFED recently put out its “Roadmap to Reduce U.S. Food Waste by 20 Percent,” a national study and action plan to cut food waste at scale.

“When we published the Roadmap report, we found a few top-level areas that can be used to accelerate food waste reduction, with one area being public policy. You can get more people involved,” says Chris Hunt, communications director for ReFED.

A lot is going on at the state level. And the first comprehensive piece of federal legislation around food waste has been in the works for a couple of years.

“Some current laws make it hard to reduce food waste, like date label laws in several states that restrict donations past a certain date,” says Hunt.

“But laws can also provide incentive to do good, like tax incentives for donating. So, laws can be a barrier, or they can be used to drive people to make better decisions,” says Emily Broad Leib, director of Harvard Law School Food Law and Policy Clinic.

In the most recent legislative session, 91 pieces of food waste-related laws were proposed in 30 states, 22 of which have passed into law.

“There’s been a lot of activity. But a lot of change is needed yet,” says Broad Leib.

Date labels especially have been up for discussion, both in proposed federal and state legislation.  Many states are now trying to change how they regulate date labels, with California passing a law and several states having introduced legislation.

But now, there is inconsistency that causes confusion. Those working to affect policy would like food to have only two labels.

When it comes to food waste, there is relatively little federal law. The few significant pieces are the Bill Emerson Good Samaritan Food Donation Act, which protects food donors and nonprofit groups that distribute food from liability associated with the consumption of donated food; the Federal Enhanced Tax Deduction for Food Donation, which allows businesses to value their food donations to qualified nonprofits; and the Federal Swine Health Protection Act, which requires that meat and animal-byproduct-containing scraps be treated by heat to kill bacteria before they’re fed to hogs. 

The 2018 federal Farm Bill has pieces of an ambitious food recovery act attached to it. Advocates pushing for a law of such large scope have faced an uphill climb, but its gaining momentum.

“Unfortunately, in recent cycles, Farm Bill politics have been deeply polarizing, with Republicans determined to cut nutrition assistance spending [one of several food-related issues the bill addresses] and Democrats clamoring to protect this safety net. Few proposals getting the most attention reflect the systems-aware orientation needed to produce food more sustainably and distribute it more equitably,” says Nicole Civita, sustainable food systems specialist at University of Colorado, Boulder.

Meanwhile, the U.S. Environmental Protection Agency (EPA) has set a national goal to cut food waste by 50 percent by 2030. And it’s looking to see what role it can play in moving toward that goal, including by improving data, as data helps show how to reach goals, said Kathleen Salyer of EPA during a Food Waste Summit co-hosted by Harvard Law School Food Law and Policy Clinic and ReFED.

One of the agency’s areas of focus is data collection around anaerobic digestion (AD) to help track capacity and to serve as a resource to facilitate AD for food waste.

ReFED is focusing on data and analytics, too. “We are hoping to impact policies and peoples’ sense of what’s valuable,” says Hunt.


Can Food Do the Same Thing as Medicine?

Originally published by Cape Cod Health News on October 5, 2018. Written by Laurie Higgins.

The phrase “food is medicine” has become increasingly popular with doctors and dieticians, but it is also the name of an ambitious new statewide health initiative that hopes to decrease food insecurity and increase health.

In 2017, the Center for Health Law and Policy Intervention at Harvard Law School (CHLPI) and the Boston-based nonprofit Community Servings partnered to launch the Massachusetts Food is Medicine State Plan.

The first step of the process is to gather information, so the non-profits created a survey to collect input from health providers, insurers and food and nutrition service providers. They also held seven regional listening sessions to hear about the best practices and the challenges each area of the state faces.

Over 50 people attended the Cape Cod regional listening session in late June of 2018. All were interested in improving access to healthy foods, and included healthcare providers, food pantry workers and representatives from elder service organizations. They shared their ideas on what programs are actually working and what some of the obstacles are on Cape Cod.

Sarah Downer, an associate director at CHLPI, led the discussion.

“Our mission as a non-profit organization is to improve access to healthcare and quality of healthcare for folks who are underserved and have chronic illness,” she said. “My division at the Center is really focused on things across the care spectrum from prevention to end of life care. We look at strategies for how we really can make healthcare work – for our healthcare systems, for the folks who are needing it.”

Food and nutrition are central to their mission, Downer said, because so many health conditions like obesity, diabetes, heart disease and cancer are all affected by diet. Healthy food can help in both the prevention and treatment of those diseases.

“We’re at this moment of transformation of the healthcare system where folks are really starting to recognize that we need to look at food in a way that we have not done before,” she said. “There are also advances in research about what happens when you actually provide medically tailored food to people who have certain health problems.”


She used the FLAVORx research studies done by Kumara Sidhartha, MD, medical director at Emerald Physicians and medical director of the CCHC Physician Hospital Organization and the CCHC Accountable Care Organization, as a local example of research that showed the link between access to healthy food and improved health outcomes.

For FLAVORx, MassHealth patients with a body mass index (BMI) above 25 were randomly divided into two groups – treatment and control. Every week for 12 weeks, the patients in the treatment group were given a prescription to buy fruits and vegetables and a $30 token for local farmers markets. The control group was given gas cards of equal value. Both groups received nutrition and cooking education from registered dietician Nicole Cormier from Delicious Living Nutrition. Farmers’ market program was handled in partnership with Sustainable CAPE.

At the end of the 12 weeks of this randomized controlled trial, the treatment group showed significant improvements in blood glucose, total cholesterol, LDL cholesterol and BMI. The next step is to convince insurance companies to explore ways of paying for food prescriptions the same way they pay for procedures and medications, Dr. Sidhartha said.

Downer agrees this makes sense not only from a health and equity perspective but also from a cost one. She pointed to another study done when Community Servings, which partnered with researchers at Mass General Hospital to look at the insurance claims from patients Community Servings had been feeding over a five-year period. Those patients showed a 16 percent net reduction in healthcare spending for patients who received medically tailored meals.

The most significant savings came from a reduction of use of the most expensive areas of service: ambulance usage, emergency department visits and in-patient hospitalizations.

“There is a value proposition to this,” Downer said. “For the cost of one day in the hospital, you can feed that person three medically-healthy meals a day for six months.”

Cost of Hunger

The cost of hunger is staggering. A recently released study done by Children’s HealthWatch and sponsored by The Greater Boston Food Bank revealed that food instability cost the state of Massachusetts $2.4 billion in increased health-related expenditures in 2016 alone.

“We’ve been looking for ways that we can incorporate and integrate food and nutrition services into healthcare delivery financing,” Downer said. “Our end goal here is that we want the healthcare systems and the food care systems to work together to connect people to the food and nutrition that they need. Food and nutrition that is not only enough calories but also food and nutrition that support in maintaining and regaining their health.”

Some of the food interventions that have been discussed for the Food is Medicine State Plan include:

  • Access to healthy food for those who are food insecure or malnourished.
  • Medically tailored food for those who are at risk for acute or chronic illness.
  • Medically tailored food for those with acute or chronic illness.
  • Medically tailored meals for seniors or those with a disability who cannot shop or cook for themselves.

Programs like Community Servings are already providing those services in their area, but the Food is Medicine State Plan seeks to make sure that all residents in the state have equal access to healthy food.

The providers at the meeting on the Cape identified access to food and nutrition services for seniors, children and youth is the largest areas of need. Lack of access to healthy food and transportation issues were also sited as issues that need to be addressed more successfully.

The Cape Cod regional information gathering session was the last one of the series. Next CHLPI will condense all the data and feedback from the seven sessions and publish a report in October. They hope to begin implementing a plan in the spring of 2019.


28 Inspirational People Working to Reduce Food Waste

Originally published by Food Tank in October 2018.

Nearly one-third of all food produced for human consumption—approximately 1.3 billion tons—is lost or wasted from farm to fork each year. Food loss and waste tends to be insidious—some is lost on the farm, some is lost in transport, waste occurs in grocery stores and at restaurants, and some is wasted in our homes.

Food waste has economic, environmental, and social repercussions, some of which are not yet quantifiable. Financially, approximately US$1 trillion of food is wasted annually. Environmentally, food waste is a drain on water resources, takes up valuable agricultural land, and negatively impacts biodiversity. Socially, wasted food equates to food that could be eaten by vulnerable populations or growing global populations.

Food Tank is excited to highlight 28 food waste warriors—inspiring chefs, scientists, activists, academics, entrepreneurs, and others who are working to prevent food loss and waste across the globe.




Emily Broad Leib (Assistant Clinical Professor, Harvard Law School), U.S.

Emily Broad Leib’s work in food law and policy in the U.S. has earned her recognition as a national leader in the subject. Founder of Harvard Law School’s Food Law and Policy Clinic, Broad Leib uses her position to tackle major issues in the food system, including food waste. Her project, “Reducing Food Waste as a Key to Addressing Climate Change,” was awarded Harvard University’s Climate Change Solutions Fund in 2015. Her work on topics such as food safety regulations and food date labels, in collaboration with others at the Harvard Food Law and Policy Clinic, has been highlighted in the media and through speaking engagements.