Island Embraces Food Is Medicine State Plan

Originally published by The Martha’s Vineyard Times on July 24, 2019. Written by Brittany Bowker.

If nutritious food prevents chronic disease and promotes long-term health, why shouldn’t it be included in our healthcare plans? That’s the notion behind Food Is Medicine, a Massachusetts coalition dedicated to increasing access to vital nutrition services for every community in the commonwealth. 

The coalition, which stems from a team at the Center for Health Law and Policy Innovation at Harvard Law School, launched June 18, and aims to connect food and nutrition with health and wellness, as well as legislative policy. On Monday, representatives from Food Is Medicine met Island stakeholders at the Martha’s Vineyard Hospital (MVH) to discuss goals, ideas, and initiatives. 

“Food and nutrition are at the cornerstone of health and wellness,” said hospital CEO Denise Schepici to a group of about 30 gathered over lunch in the hospital’s community room. Representatives from Island Grown Initiative (IGI), the hospital, Island Health Care (IHC), Family Planning, Social Services, Elder Services, and the Island Food Pantry, among other invested community members, attended.

According to a study from the Greater Boston Food Bank and Children’s HealthWatch, food insecurity costs the state $1.9 billion in annual healthcare costs.  

“The cost of the healthcare system increases as severity of food insecurity increases,” said Sarah Downer, primary author of the Food Is Medicine state plan. “If someone is in the hospital and they’re malnourished, it’s going to be more expensive to the system … We want to explore what role the healthcare system plays when it interacts with the food system.” 

The Food Is Medicine coalition came up with four intervention initiatives:

  • Medically tailored meals designed by a registered dietitian to respond to a specific medical condition. 
  • Medically tailored groceries, a package of nonprepared grocery items selected by a registered dietitian as part of a treatment program. The recipient is usually capable of picking up the food and preparing it at home. 
  • Produce prescription/voucher programs for free or discounted produce distributed by healthcare providers to address a specific health condition. Redeemable at retail grocery stores, farmers markets, or CSA (community-supported agriculture) programs.
  • Population-level healthy food programs, where antihunger programs partner with healthcare providers to distribute healthy food to any patient regardless of health status. 

The hospital and IHC, along with health providers across Massachusetts, have begun adopting these initiatives. The hospital has rolled out two food insecurity primary-care screening questionnaires developed by Hunger VitalSign and Children’s HealthWatch to identify young children and families who may need assistance, with inquiries like these:

  • Within the past 12 months, we worried whether our food would run out before we got money to buy more. 
  • Within the past 12 months, the food we bought just didn’t last, and we didn’t have money to buy more. 

“People are more frank when asked to answer a questionnaire,” said Aletheia Donahue, primary-care physician at MVH. “It’s an effective, validated screening tool where we can get data and compare it with other institutions.”

IHC is rolling out a similar screening questionnaire for all social determinants of health, according to Kathleen Samways, chief quality officer at IHC. “We know we have something really big to tackle,” Samways said. 

Just this week, IHC launched a produce prescription pilot in partnership with IGI. Six chosen patients will receive free locally grown produce and free cooking classes. 

“We’ll start getting a sense for the way these programs can influence blood pressure, weight, and shopping habits,” said Noli Taylor, community food education director at IGI. 

“Patient profiles show the need is huge,” said IHC nurse practitioner Marcia Denine. 

Food Is Medicine is also focused on getting food access resources ingrained in statewide healthcare systems. “We want to make sure healthcare providers are equipped with all the information they need to screen a patient for food insecurity,” Downers said. “It would be ingrained in the system. There would always be something in the community for the patient to be referred to.” 

Taylor gave an overview of the existing food-equity services on Martha’s Vineyard. Among them are the Food Equity Network, a group of over 22 organizations focused on tackling food equity issues on the Island. There’s the Island Food Pantry, which doubled its number of clients between 2017 and 2018, and is seeing a 30 to 80 percent monthly increase in 2019, according to Island Food Pantry executive director Kayte Morris. The Island also has robust SNAP, WIC, and HIPservices. According to Taylor, more than 600 Islanders utilize SNAP, which represents a fraction of individuals who could sign up for those services. “More outreach and coordination are necessary, and I’m looking forward to being a part of that,” said Eve Gates of Dukes County Social Services. 

The Island clergy are another robust food and grocery voucher distributor. Mandi Moran of the Good Shepherd Parish said they distributed 75,000 pounds of food in one year. There’s a food resource hotline, 508-693-7900, ext. 410, launched by Martha’s Vineyard Community Services in partnership with IGI. IGI’s gleaning program has collected and redistributed 25,000 pounds of produce from local farms, and 1,000 pounds of produce from grocery stores. IGI also has a processed-food program, and a partnership with Kitchen Porch Catering to prepare and freeze food to make it easier for Islanders to eat. IGI is expanding its processing program with Camp Jabberwocky this winter. IGI also offers a free lunch program, and a year-round Mobile Market. 

“Even though so many of us are working on this, we know we’re not reaching everyone,” Taylor said. “We’re excited to be working with the hospital and health center. Together we can have a stronger food-equity support structure, and our programs will be more impactful.” 

“The hospital is committed to being a ‘Food Is Medicine’ leader,” Donahue added.

Food Is Medicine is working closely with state policy and legislation. “We’re in the business of making sure we’re on the agenda,” Downer said. Sen. Julian Cyr, D-Truro, was supposed to appear at Monday’s gathering, but had a prior engagement. Cyr, who represents the Island in the state Senate, has been instrumental in getting Food Is Medicine through to policymakers, according to Downer.

“In the healthcare legal and policy world, it’s hard to get people to pay attention until you have studies,” Downer said. “We now have bodies of emerging research showing things we’ve been witnessing.”

“This is all very heartening to me,” IGI executive director Rebecca Haag concluded. “The only way we start making a difference is if we collaborate and cooperate — just sharing information. Let’s get back together in a year and see how far we’ve come.”

 

USDA Gave Almost 100 Percent Of Trump’s Trade War Bailout To White Farmers

Originally published by FBLE on July 24, 2019.

Last July, the Trump administration announced a major new subsidy program designed to help farmers weather America’s ongoing trade war with China. That initiative—dubbed the Market Facilitation Program (MFP)—has become the single largest source of subsidies for farmers.

While many writers have documented the struggles of farmers affected by the trade war, few have scrutinized the distributional effects of the MFP. The Environmental Working Group (EWG) has documented that the program has disproportionately helped wealthy landowners and a recent analysis by Donald Carr, a senior advisor for EWG, argues that the MFP has deepened the disadvantages of black and minority farmers.

We extend EWG’s analysis with data we obtained from a Freedom of Information Act (FOIA) request. The MFP has almost exclusively benefitted white men and their families, who appear to be disproportionately upper middle-class or wealthy. These payments further entrench already drastic inequalities in agriculture, along racial, ethnic, gender, and class lines.

The White House announced the MFP in response to large, retaliatory tariffs that the Chinese government imposed on most agricultural products from the U.S. in April 2018. Prior to 2018, China had either been the largest or second largest buyer for U.S. agricultural goods each year since 2008. Agricultural exports to this massive market declined quickly after the tariffs were put into place, reducing the prices farmers received for many important commodities, especially soybeans. In response, the Trump administration announced in July 2018 that it would provide farmers with up to $12 billion in aid to help them make up for lost revenue from the trade war.

These payments are large enough to constitute the single largest source of subsidies for farmers. During the Obama administration, the federal government provided operators with roughly $15 – $20 billion annually through agricultural subsidy programs. These subsidies were primarily distributed through crop insurance, commodity payments, and conservation programs, which, together, make up the modern farm safety net. The MFP is larger than any of these single programs and has substantially increased the amount of subsidies farmers are receiving.

Similar to other USDA subsidies, the MFP has overwhelmingly favored white and male producers. We recently received data from a FOIA request that show the department has funneled more than 99 percent of bailout funds to white operators.

As of today, USDA has distributed more than $8.5 billion to farm operations through the MFP. Of the approximately $8 billion distributed to operations whose owners’ race could be identified, 99.5 percent went to white business owners. Of the more than $6.8 billion distributed to operations in which the owners’ gender could be identified, more than 91 percent went to male business owners. “White farm operators” here includes white Hispanics, but they only account for about 0.1 percent of the total. In other words, non-Hispanic white operators received 99.4 percent of all MFP payments.

Note: Approximately seven percent of the funds went to entities owned by corporations or individuals whose race was not reported.

The racial disparities are just as stark in states with sizable non-white farmer populations. In Mississippi, for example, where 38 percent of the population is black and 14 percent of farms have a black principal operator, according to the 2017 Census of Agriculture, only 1.4 percent of the $200 million distributed to farmers through the MFP went to black operators.

Not only did almost all of the funds go to white operators, but an overwhelming share of the funds appear to have gone to upper-middle class and wealthy families. The average family that produces soybeans has a much higher income—and a lot more wealth—than the average family in the U.S. But a disproportionate share of MFP money has been paid out to families operating large-scale farms, who have even more wealth.

According to data we received from a separate FOIA request, the largest 11 percent of soybean producers applying for MFP funds received 52 percent of all soy payments through February 20. Meanwhile, the largest 3 percent received more than a quarter of all payments.

The Trump administration plans to distribute up to an additional $14.5 billion to farm operators for crops produced this year. Most of that money will go to well-off white families.

These disparities are the result of historical and recent discrimination. The federal government played a role in withholding farmland from, and dispossessing, farmers of color, especially black and Native American ones. And as we documented in a recent article, USDA has done little to address its atrocious civil rights record. The MFP continues to exacerbate these racial inequalities today.

FLPC Welcomes New Team Member Melissa Shapiro

The Harvard Law School Food Law and Policy Clinic (FLPC) welcomes Melissa Shapiro to the team as a Clinical Instructor!

Melissa joined the Harvard Law School Food Law and Policy Clinic in July 2019 as a Clinical Instructor.

Immediately prior to coming to FLPC, Melissa served as a consultant to the UN Office of the High Commissioner for Human Rights, working with the Special Rapporteur on the Right to Food to increase the visibility of the right to food mandate, and as an Attorney-Advisor with the U.S. Environmental Protection Agency’s Office of General Counsel. Melissa received her J.D. and Master of Environmental Law and Policy from Vermont Law School in 2016, where she led the Food and Agricultural Law Society and worked with Hunger Free Vermont as a Schweitzer Fellow. Melissa received her B.A. in Human Ecology from Middlebury College in 2013. She is a licensed member of the bar of the State of New York.

New Documentary To Explore Food Waste Solutions And Their Cost Benefits

Originally published by Forbes on July 23, 2019. Written by Natalie Parletta.

When documentary filmmaker Karney Hatch started visiting Heart 2 Heart Farms in Sherwood, Oregon, he says he was astounded to witness the five million pounds of food the owners rescue from its trip to landfill every year.

“Even after having visited the farm many times,” he says, “it still takes my breath away to drive up and see 10,000 pounds of fresh nectarines or pallet after pallet of avocados, fresh off the truck.”

And this is just a small fraction of the bigger picture nation- and world-wide. “The scope of the problem is just enormous,” he says.

This gave Hatch the inspiration for a new documentary, “Robin Hoods of the Waste Stream”.

The film will look into scalable solutions to the problem of food waste through interviews with a large cast of leading crusaders including [Emily Broad Leib (Harvard Law School Food Law and Policy Clinic)], Tristram Stuart, “the godfather of the food waste movement”, food waste warrior Dana Gunders, and Ben Simon of Imperfect Produce.

His latest documentary on tackling food waste is in the final stages of fundraising on Indiegogo.

“One moment that really crystallized the problem for me,” Hatch says about this film, was when the Heart 2 Heart farm’s cofounder, Tyler Boggs, noted that every week, several truckloads of edible produce headed to landfill go past a nearby school with children who are on free or reduced lunch.

“I mean, this is not rocket science,” he adds. “This is low-hanging fruit when it comes to solvable problems.”

It really highlights that the issue of food insecurity is not through a lack of resources – it is logistical. For this reason, Under 30 leader Komal Ahmad of Copia calls food waste “the world’s dumbest problem”.

It’s estimated that a third of all food produced, amounting to nearly $1 trillion dollars every year and 1.3 billion tons in weight, is never eaten. Not only could this wasted food feed the world’s 805 million hungry people more than four times over, it is one of the planet’s biggest environmental problems.

Growing food that never gets eaten uses a quarter of the world’s precious fresh water, equivalent to the yearly flow of Russia’s Volga River, according to a United Nations Report. Formerly forested land that is used to produce it takes up an area larger than China. It comprises a third of landfill and its production, harvesting, transportation and packaging releases 3.3 billion tons of carbon dioxide each year, making it the third-largest emitter of greenhouse gases after the U.S. and China.

Recognizing the urgency of this problem, the United Nations devoted one of its sustainable development goals to cutting global food waste at the retail, consumer and supply chain levels in half by 2030.

Economically, it’s a no-brainer to fix it. Hatch says it “continues to blow my mind” that projects to address food waste can save businesses money. For instance, a 2017 study found that companies across a range of industries could save around $14 for every $1 invested in food waste reduction.

Hatch heard many similar stories from his interviewees.

“The most duplicable and striking of these for me,” he says, “is a great project at a shopping mall in Sao Paulo, Brazil (Shopping Eldorado).” The team collected food scraps from the mall’s huge food court and converted it to compost, which they then used to fertilize a rooftop vegetable garden.

In turn, the fruits and vegetables from the garden are given free to employees and the mall saved the money it would have cost them to ship the food waste to landfill. “This means that there’s absolutely no reason that every mall in the world shouldn’t duplicate this project, or something similar,” says Hatch.

In another story, Ben Simon talks about why his brainchild has gone from zero to 1,000 employees since 2015 – the initiative to promote “ugly” organic fruits and vegetables (which are rejected by supermarkets) really caught on. Hatch says that Simon “felt like the idea of ‘the underdogs of produce rising up and getting their day’ really resonated with people’.”

This idea really hit home for him as well. “Our environment is in real peril, and we ourselves are the underdogs in the face of climate change, water and energy shortages, etc. We must find ways to have lots of underdogs get their day if we’re going to leave a habitable planet for the next generation.”

The documentary’s driving mission is to inspire people to copy successful models, which will benefit non-profits and entrepreneurs alike – not just beneficiaries of the world’s Robin Hoods.

“Unfortunately, at this point in history, there is so much waste to go around that it’s become a resource,” Hatch says. After people watch the documentary, he wants them “to get out of their seats and feel like they can either go support one of the projects they’ve seen in the film, or even go start their own.”

New Toolkit Provides Guidance on Organic Waste Bans

Originally published by Waste Today Magazine on July 17, 2019. Written by Theresa Cottom.

Harvard Food Law and Policy Clinic (FLPC), based in Cambridge, Massachusetts, and the Center for EcoTechnology (CET), a nonprofit environmental consultant for businesses based in Pittsfield, Massachusetts, have released a new toolkit on state and local organic waste bans. 

Bans and Beyond: Designing and Implementing Organic Waste Bans and Mandatory Organics Recycling Laws serves as a resource for state and local policymakers, regulators and advocates interested in policy solutions to reduce food waste and keep food out of landfills.

Bans and Beyond examines the legal landscape of existing state and local organic waste bans. This landscape is constantly evolving: six states and seven municipalities across the country have now passed organic waste bans, and three of these policies passed within the last year. The toolkit analyzes the structure of these different policies and the challenges that jurisdictions have faced in implementing them—for example, challenges with accessing funding, developing effective enforcement mechanisms and building sufficient organics recycling infrastructure.

The toolkit also analyzes nine additional sets of policies and programs that can be implemented to incentivize waste reduction. These policies are essential to creating an environment where organic waste bans can succeed and can also be effective policy tools to reduce food waste in states where an organic waste ban or recycling mandate may not be feasible, FLPC says. 

For example, states and localities can provide grant funding for food waste reduction, recovery and recycling programs; revise permitting and zoning regulations to facilitate the development of composting facilities and anaerobic digesters; and implement pay-as-you-throw systems that charge residents based on the amount of waste they throw out in order to encourage residents to reduce their waste disposal and increase recycling and composting.

This toolkit builds on other resources FLPC has produced to support states and localities in addressing food waste through policy. FLPC’s 2016 toolkit, Keeping Food Out of the Landfill, offers an array of policy suggestions for reducing food waste, from strengthening food donation liability protections to implementing organic waste bans. The most recent toolkit builds on that with much more detail about organic waste bans.

In recent years, state and local governments have explored policies to reduce the 40 percent of food in the U.S. that goes to waste. Organic waste bans are one of the most innovative categories of policies, FLPC says in a news release. By restricting the amount of food waste that businesses and individuals can dispose of in landfills, organic waste bans can drive adoption of more sustainable practices. 

FLPC says cost-benefit analyses have shown the potential of organic waste bans to reduce greenhouse gas emissions while stimulating local economies and creating green jobs. In Massachusetts, the state’s organic waste ban supported over 900 jobs in the organic waste hauling, processing and food rescue industries in 2016 and generated $175 million in industry activity.

New Toolkit Aims to Keep Food Waste Out of Landfills

Originally published by Waste360 on July 18, 2019.

Forty percent of food in the United States goes to waste—this amounts to $218 billion each year spent on food that is never eaten. The majority of this wasted food ends up in landfills, where it produces harmful greenhouse gases and contributes to states and localities running out of landfill capacity. “Bans and Beyond: Designing and Implementing Organic Waste Bans and Mandatory Organics Recycling Laws,” published by the Harvard Law School Food Law and Policy Clinic (FLPC) in partnership with the Center for EcoTechnology (CET), is a resource to advise states and localities looking to address food waste through policy.

Organic waste bans are an innovative policy solution to divert food waste from landfills. These policies limit the amount of organic waste, including food waste, that businesses and individuals can dispose of in landfills. Organic waste bans thus drive more sustainable practices, such as food waste prevention, food donation, sending food scraps to animal feed operations or sending food waste to composting or anaerobic digestion facilities. Just 10 years ago, these policies were largely unheard of; today, six states and seven municipalities have passed organic waste bans. 

“Food waste takes up space in landfills, contributes to climate change and is a drain on the economy,” said Emily Broad Leib, director of FLPC, in a statement. “Organic waste bans are one of the best tools we have seen that states and localities can use to transform business practices and drive the development of food waste recycling infrastructure.”

“Over the years, we’ve seen firsthand how waste bans and the other policies and programs discussed in the toolkit can drive innovation and significantly reduce wasted food,” said John Majercak, president of CET, in a statement. “The resulting impact is a big win for communities, regional economies and the environment.”

FLPC Releases Organic Waste Bans Toolkit

The Harvard Law School Food Law and Policy Clinic (FLPC) and the Center for EcoTechnology released a new toolkit today on state and local organic waste bans, policies that restrict the amount of food or organic waste that can be sent to landfills. Bans and Beyond: Designing and Implementing Organic Waste Bans and Mandatory Organics Recycling Laws serves as a resource for state and local policymakers, regulators, and advocates interested in policy solutions to reduce food waste and keep food out of landfills.

40% of the food in the United States goes uneaten. The challenge of food waste has significant impacts on the economy, food insecurity, and the environment. Not only does this wasted food require a significant amount of water and energy to produce, but most of it ends up in landfills, where it breaks down and generates methane, a potent greenhouse gas. And now, cities and states are facing an additional barrier: they are running out of space to store trash.

In recent years, state and local governments have explored policies to reduce food waste. Organic waste bans are one of the most innovative categories of policies. By restricting the amount of food waste that businesses and even individuals can dispose of in landfills, organic waste bans can drive adoption of more sustainable practices. Cost-benefit analyses have shown the potential of organic waste bans to reduce greenhouse gas emissions while stimulating local economies and creating green jobs. In Massachusetts, the state’s organic waste ban supported over 900 jobs in the organic waste hauling, processing, and food rescue industries in 2016 and generated $175 million in industry activity.

Bans and Beyond examines the legal landscape of existing state and local organic waste bans. This landscape is constantly evolving:  six states and seven municipalities across the country have now passed organic waste bans, and three of these policies passed within the last year. The toolkit analyzes the structure of these different policies and the challenges that jurisdictions have faced in implementing them—for example, challenges with accessing funding, developing effective enforcement mechanisms, and building sufficient organics recycling infrastructure.

The toolkit also analyzes nine additional sets of policies and programs that can be implemented to incentivize waste reduction. These policies are essential to creating an environment where organic waste bans can succeed, and can also be effective policy tools to reduce food waste in states where an organic waste ban or recycling mandate may not be feasible. For example, states and localities can provide grant funding for food waste reduction, recovery, and recycling programs; revise permitting and zoning regulations to facilitate the development of composting facilities and anaerobic digesters; and implement “pay as you throw” systems that charge residents based on the amount of waste they throw out, in order to encourage residents to reduce their waste disposal and increase recycling and composting.

This toolkit builds on other resources FLPC has produced to support states and localities in addressing food waste through policy. FLPC’s 2016 toolkit, Keeping Food Out of the Landfill, offers an array of policy suggestions for reducing food waste, from strengthening food donation liability protections to offering tax incentives for food donors to implementing organic waste bans. Today’s toolkit builds on that with much more detail about organic waste bans.

With greater public attention on food waste, organic waste bans have become increasingly popular in the years since Keeping Food Out of the Landfill was published. Organic waste bans have the potential to transform waste management systems and drive food waste reduction, recovery, and recycling. FLPC hopes that Bans and Beyond will support state and local efforts to identify and advance organic waste management policies that are the best fit for the local context.  

Read Bans and Beyond: Designing and Implementing Organic Waste Bans and Mandatory Organics Recycling Laws.


Attend the Bans and Beyond Webinar

Want to learn more about Bans and Beyond: Designing and Implementing Organic Waste Bans and Mandatory Organic Recycling Laws? Join us for a webinar on July 30 at 3:00PM ET.

Register for the webinar!

Revolutionizing the Food Systems in Israel and U.S.

Originally published by ynetnews.com on July 6, 2019. Written by Sarah Vorsanger.

Education is an essential way to make the general public aware of the food they are eating. School children in Israel are learning healthy, fun eating habits from an early age by growing their own vegetables in newly implemented school gardens and learning healthy recipes from older students that they can make with their parents at home.

Professor Emily Broad-Leib, Director, Harvard Food Law and Policy Clinic at Harvard University was the keynote speaker at a lecture regarding food systems and strategies given at Tel Aviv University in May.

“This is the beginning of an opportunity to share ways the U.S. and Israel are similar and different in food strategies,” says Broad-Leib. 

The various initiatives to grow food in schools shows the “level of thoughtfulness and sophistication in Israel” that could be brought to the U.S., says Broad-Leib.

These new programs have a long lasting societal impact on children in a way that shows them the need to make conscientious and healthy food based decisions.

Dr. Efrat Oron, the Director of Research & Outreach of the Manna Center Program for Food Safety and Security at Tel Aviv University, defines the food system as “the entire envelope from designing, producing, storing, packaging, distributing, consuming, and wasting of food.”

Maya Oren, Program Director of the Manna Center, adds that “to think of the food system in a circular way is a new concept that is only about 15 years old.”

Regulating the food systems

“From my time here, what I am seeing on food policy and matters, in general, is that there are more similarities than differences,” says Broad-Leib.

Growing environmental and health concerns are forcing us to change how we interact with our food system, but this comes with its own challenges. In the U.S., many government offices have different roles in the food system, but since they are isolated from one another, they lack communication, and their oversight is inconsistent and insufficient. 

 

Israel has similar issues when it comes to communication. Oron explains that ministries should communicate and reach agreements together, however, they are not.

According to Professor Ronit Endevelt, Nutrition Division Manager of the Ministry of Health and lecturer in the School of Public Health at Haifa University, who was also presenting at the lecture, it takes a lot more time and work to pass new laws with today’s government.

Professor Nir Ohad, head of the Manna Center, explains that in Israel, “there are closer connections to agriculture since we evolved as an agricultural country. Agriculture is in the DNA of the society.” He adds that there is a “tight link between what we produce and what we eat.”

He notes that Israel’s food system is only independent when it comes to fruits and vegetables.

National food strategies

Israel, like the U.S., is a melting pot. However, according to Broad-Leib, the U.S. does not have a healthy, native cuisine that ties its people together as the Mediterranean diet does for Israelis. Therefore, it is harder to find common ground when explaining what Americans should and should not eat. The National Nutrition Security Council under the Ministry of Welfare, works with Non-Governmental Organizations (NGOs) to collect food waste from the industry. The name of this council, according to Oren, is misleading. “The scope is extremely limited since they are dealing with poorest people in Israel. Their focus is a very ‘now’ approach, which is not looking to solve food security. This is not a food systems approach,” she says.

There is not much oversight in the foods delivered in food baskets to those in need. While the basket provides overall sufficient dietary quality, Ohad, Oron, and Oren agree that the food baskets may not be the healthiest or culturally appropriate.

“This is where the Ministries of Health and Welfare butt heads,” say Oren and Oron.

Why do we care?

“Food is a powerful topic. Everyone has an opinion on food because everyone interacts with the food system on a daily basis,” says Broad-Leib.

There has been an increase in diabetes, obesity, and heart disease in both the U.S. and Israel. Trends in the U.S. show that as household income decreases, money spent on food increases.

In Israel, Endevelt attributes these health risks to the fact that families are not cooking. She also says that since the cost of fruits and vegetables has increased by 45% while ultra-processed foods are cheap, these unhealthy foods are the main nutritional problem in Israel.  

Environmental impacts are also prevalent. Broad-Leib mentions that the agricultural industry uses 70-80% of the water in the U.S., while 20% of this water goes to watering crops that will eventually be thrown away.

Since a third of the greenhouse gases emitted in the U.S. comes from this industry, the third best way to reduce this is by cutting down on food waste. Right now 30-40% of food all food is wasted in both the U.S. and Israel.

Improvements to the food system

As Director of the Harvard Food Law and Policy Clinic, Broad-Leib aims to make policy changes to the food system in the U.S. by educating law students on how to write legislature and providing legal advice for companies regarding food. She also launched the academy of food in law and policy.

During her time director, she and her students have helped farmers receive subsidies and support from the government as well as improve bills to reduce food waste. “Last year’s U.S. Farm Bill had nine food waste provisions, and seven of those were written by us,” says Broad-Leib. “Policy takes time, but we have had a lot of success,” she added.

In Israel, an initiative recently passed that will implement healthy foods in schools starting next year. Endevelt explains that this was a difficult law to pass because all the food contracts had to be canceled. “These old contracts focused on food safety, but now they will also provide healthy food too,” she says.

Other recent initiatives include nutrition guidance and monitoring at Well Baby Clinic nationally, healthier options in vending machines at hospitals, and incentivizing Health Maintenance Organizations (HMOs) to provide nutritional education for selected groups.  

 

In 2020, the Ministry of Health will put red stickers to all products in Israel that have a high amount of sugar, sodium, and/or saturated fats, and green stickers to healthier food options. Endevelt hopes that consumers will choose healthier products, and companies will change their recipes if their product has been given a red sticker.

What else should be done?

Since it is easy for people to turn a blind eye to the food that they eat, Broad-Leib encourages the use of media outlets to promote policies pertaining to the food system, whether it is about food waste or utilizing resources sustainably. Sustainability is a necessity of the food system. “You can’t give someone advice on food without including this concept,” says Broad-Leib. “If we don’t tend to a more sustainable food system (i.e., increased pay and livelihood of farmers and workers in the industry), more people will be food insecure in the future.”

Analysis: Trump’s Hospital Costs Transparency Executive Order Faces Uphill Battle

Originally published by Healio on July 1, 2019. Written by Janel Miller.

Though some major medical societies applauded President Donald J. Trump’s executive order on June 24 directing HHS to require hospitals upfront disclosure of prices, it faces difficulty coming to fruition, medical, legal and economic experts told Healio Primary Care.

Background

The executive order states that HHS issue a rule within 60 days that requires hospitals to publicly reveal the cost patients will pay for services in an “easy-to-understand, consumer-friendly, and machine-readable format using consensus-based data standards that will meaningfully inform patients’ decision making and allow patients to compare prices across hospitals.”

The executive order also gives HHS 90 days to seek proposals to make information on out-of-pocket spending more accessible to patients before receiving care. “[This] will create unprecedented transparency about health care prices and provide this information to the American people for the first time ever,” Trump said at a press conference announcing the executive order.

“You’ll be able to search out for the right doctor. And it really is, in a true sense, the opposite of Obamacare. You’ll get much better pricing, and you’ll get the doctor that you want and maybe you’ll get better than the doctor that you originally thought about,” he added.

 

Analysis

Experts interviewed for this story commended the administration’s move towards transparency, but said that implementing Trump’s executive order – from historical and contemporary standpoints – is likely easier said than done.

“More information is almost always a good thing,” Arthur Caplan, PhD, founding head of medical ethics at New York University School of Medicine, said. “But Trump’s initiative is a return to the 1960s when health care was built around the idea of shopping and the invalid assumption that the free market would drive down costs.”

Nancy Nielsen, MD, PhD, a former senior advisor at CMS during President Obama’s tenure and now senior associate dean for health policy at the University at Buffalo, explained to Healio Primary Care some of the executive order’s potential barriers.

“Transparency is sorely overdue, but not as simple and one-size-fits-all as Trump implies. A lot of what patients pay at hospitals is related to their insurance. These prices vary based on who is the insurer and who purchased the insurance plan,” she added.

“There’s a perverse consequence to disclosure that Trump is ignoring,” Memo Diriker, DBA, MBA, founding director of the Business, Economic and Community Outreach Network at Salisbury University in Maryland, added. “Historically, such negotiations usually go in favor of the industry or organization rather than the consumer. Think about how high the salaries of some university presidents and K-12 school superintendents are. These only got that way once those amounts started becoming publicly available.”

 

Diriker and others also said that there are other reasons why, through no fault of the hospital, the executive order is impractical. “Are we really going to negotiate our health care the way we negotiate with a pain paint contractor for our households? If we are having a medical emergency, are we really going to take time to shop for the best deal? Of course not. In most such instances, we rely on a physician’s advice, not a financial planner’s tips,” Diriker noted.

 

“The idea that individuals will suddenly begin making decisions for health care based on this information is a leap of faith. Most people, particularly those with lower socioeconomic statuses, aren’t able to ‘shop around’ for health care even with this information,” Phil Waters, JD, clinical fellow at the Center for Health Law and Policy Innovation at Harvard Law School, added.

Many of the experts also cited Trump’s lack of specifics regarding implementation as an additional cause for doubt.

“The devil may be in the details,” Diriker said. “There is no one price in play here, and we don’t know yet what prices they are referring to.”

Caplan and Nielsen agreed the executive order falls short on specifics.

“He described an idea, but didn’t even suggest where these prices would be posted: hospital doors? Websites? The executive order does not have the requisite details that are needed,” Caplan said.

“There is a lot that is aspirational here, but there is very little on how it will happen,” Nielsen added.

Pushback anticipated

Other experts discussed the pushback the administration will likely receive as it attempts to bring the executive order to reality.

“I can see hospitals and health plans warning that this could actually increase the cost of health care, either by adding administrative costs, focusing health care on volume as opposed to quality, or simply because once physicians know what the competition is being paid, their incentive is to match the same prices which may be higher than their own,” Waters told Healio Primary Care.

Nielsen concurred. “Price negotiations between health insurance companies and hospitals are closely held secrets. If you make the prices known, the lower-charging hospital is going to revolt and say they want equal pay for the same work,” she said in the interview.

90% politics; 10% ideology 

With the 2020 presidential campaign already underway, Diriker suggested Trump may have issued the executive order for political gain, not patients.

“His idea will sound great at a rally filled with potential voters,” Diriker said. “But what he will never say, and is important to note, is that though hospitals charge high prices, individual patients will never be able to negotiate the lowest prices.”

 

Caplan also indicated a potential election-related motive for the executive order. “This initiative is 90% politics so that he has something positive to say about health care while on the campaign trail,” he said. “The other 10% is Republican ideology. Most Republicans don’t like ‘Medicare for All’ or government-sponsored health care but do like the market-oriented ideas put forth by this executive order.” -sponsored health care but do like the ideas put forth by this executive order.”

Possible solutions to high costs

Some of these experts offered suggestions for bringing hospital costs down, mindful of the critical nature of their comments. “We should consider more resources like FAIR Health,” Nielsen told Healio Primary Care. “This independent nonprofit organization gathers and manages the nation’s largest database of privately billed health insurance claims, uses the information to support business decisions about out of network claims and helps consumers anticipate the likely costs of their care for a given procedure,” she added.

 

Caplan suggested the U.S. government play a role in health care that mirrors some European countries’ procedures. “The government needs to exercise its bargaining clout like Germany and Holland do. These countries’ have a minimum health insurance mandate and then patients can add options, like U.S. residents do say with private automobile insurance.”

Other executive order components

 

Trump’s executive order also increases patient access to health savings accounts and claims data, requires several agencies to provide details on how the federal government or private sector hamper with health care price and quality transparency, and tasks several agencies with improving data and quality measures reporting systems across government programs. These components are expected to be completed within 180 days of the executive order’s issuance.

Response to the executive order

Some medical groups seemed receptive to at least part of the president’s executive order as they anticipated next steps.

“The American Academy of Family Physicians shares the administration’s goal of improving health care transparency,” Michael Munger, MD, chair of the AAFP board said when asked by Healio Primary Care for his thoughts on Trump’s initiative.

 

“By informing patients about the quality and costs, we can empower them to navigate the health care system more efficiently. We look forward to seeing and analyzing the forthcoming regulations that will attempt to achieve the proposals outlined in the President’s executive order and to submitting comments to the proposed regulations when they’re published,” he added.

The ACP also appeared enlightened by the president’s initiative, but with a caveat. “We firmly believe that increasing health care transparency is critical in providing quality, affordable, and accessible health care coverage to patients who need it the most,” Robert McLean, MD, president, ACP said in a statement. “While ACP supports the concept of the executive order, it should be implemented in a way that does not impose impracticable or excessive administrative burdens.”