March 3 Lunch Event: Preventing Food Waste: Creating Family Meals

The HLS Green Team, the Harvard Law School Food Law and Policy Clinic, and the Office of Clinical and Pro Bono Programs  is proud to co-sponsor PREVENTING FOOD WASTE: Creating Family Meals, a discussion about the Family Meals Program at Harvard.

Please join us on TUESDAY, MARCH 3RD from 12-1pm in WCC 3018 where Professor Emily Broad Leib will moderate a conversation with Sasha Purpura (Executive Director of Food for Free) and Gwen Koch (the Manager of the Food Literacy Program at HUDS) about the program that turns otherwise wasted food into healthy meals for food insecure individuals.

Welcome to New Staff: Kyra Sanborn, Advancement Officer

The Center for Health Law and Policy Innovation is pleased to welcome a new member to our staff, Kyra Sanborn.

Kyra Sanborn
Advancement Officer, Press and Media Contact, 617.496.1507

Kyra joined the Center for Health Law and Policy Innovation as an Advancement Consultant in August 2019. Currently serving as Advancement Officer, Kyra supports the Center’s development and strategic communication efforts, including all press and media requests.

Prior to joining the Center, Kyra served as Grants Administrator for Philadelphia Health Partnership (PHP), a foundation focused on increasing health equity and addressing the social determinants of health through the integration and coordination of care and services. At PHP, Kyra managed the grantmaking process, assisted with the development and launch of a five-year strategic plan, and supported communication efforts both internally and externally. Kyra has worked with several other organizations in various capacities, including as a grant report writer for Keystone Development Partnership’s union apprenticeship programs, as a volunteer for National Street Service’s efforts to make streets more human-centered, and as a foreign English teacher at schools in Thailand, Vietnam, and Colombia. Kyra received her B.A. in Communications from Temple University, and a certificate in ascending leadership from Bryn Mawr’s Graduate College of Social Work and Social Research.

In soda tax fight, echoes of tobacco battles

Originally published on February 18, 2020 by The Harvard Gazette. Written by Alvin Powell.

Amid rising rates of diabetes and obesity in the nation, Berkeley, Calif., became the first American city to institute a sugary-drink tax, generally referred to as a soda tax, in 2015.

Since then a handful of jurisdictions, such as Philadelphia, Seattle, and Boulder, Colo., have passed similar measures. Other proposals have failed at the ballot box or been rescinded. New York proposed a rule capping portion sizes in 2012, which was successfully challenged in state court.

The regulation push-pull continues as soda-tax citizen advocates and public-health professionals brace for the long haul and draw lessons from the tobacco wars about how tough a fight lies ahead against a deep-pocketed industry adept at political and public relations warfare.

“I think it’s a question of time” before soda taxes become more common, said Steven Gortmaker, professor of the practice of health sociology at the Harvard T.H. Chan School of Public Health. “It’s a battle, though.”

In some ways, the obesity epidemic itself is an ally of those supporting a tax: It’s not going away and it’s only going to get worse. A study by Gortmaker and colleagues published in December projected that in 10 years, half the adults in America will be obese and a quarter severely obese. Obesity won’t be uniformly distributed, however, and more than half the population will be obese in 29 states. A related study, he said, shows that more than half of U.S. children will be obese by age 35.

“Consuming sugary beverages every day slowly kills you,” Gortmaker said. “I know it sounds terrible, but it’s kind of like cigarettes. In the short run it doesn’t have too much effect, but that excess weight gain does accumulate. … Twenty, 30, 40 years later it’s called obesity or severe obesity.”

Though diet is complicated, sugary drinks are a relatively clear target, Gortmaker said. American diets are awash in added sugar, more than half of which comes from sugary drinks, he said. Raising taxes as a way to cut consumption is a tried-and-true governmental approach, one that worked well with tobacco and that takes advantage of existing tax-collecting infrastructure, rather than requiring elaborate new programs.

Emily Broad Leib, clinical professor of law and head of Harvard Law School’s Food Law and Policy Clinic, said that along with obesity, rates of diabetes have risen until the condition now affects nearly 10 percent of the population. Fifty years ago, she said, less than 1 percent of Americans had Type 2 diabetes.

“We have a really serious health crisis going on,” Broad Leib said. “People are ill and not able to live a long and healthy life.”

Gortmaker and Broad Leib discussed sugar-sweetened beverage taxes at Harvard Law School’s Wasserstein Building on Friday. The event was sponsored by the School’s Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, together with Harvard Medical School’s Center for Bioethics and Brigham and Women Hospital’s Program on Regulation, Therapeutics, and Law. The hourlong event was moderated by Petrie-Flom Center Executive Director Carmel Shachar.

While soda taxes can be effective — Berkeley’s resulted in an estimated 52 percent drop in consumption of sugary drinks — they can also raise significant funds. Philadelphia’s tax, for example, has raised $70 million a year.

Broad Leib said the experience of Cook County, Ill., indicates the difficulty of the fight ahead, however. The county, which includes Chicago, approved a sugar-sweetened beverage tax in 2016, only to repeal it under pressure from retailers and others a year later.

Opponents attack the taxation efforts as increasing the “nanny state” and impinging on individual autonomy — even if an individual’s choices aren’t the healthiest ones. Opponents argue that the taxes hurt local businesses, an argument that studies show does bear some weight, as Philadelphia’s experience shows an increase in sweetened beverage sales in surrounding communities.

In the courts, the rulings have hinged on quirks of each case and, while the courts have struck some provisions against sugary beverages, they haven’t ruled that the taxes are unconstitutional. One problem, Broad Leib said, is that the cases are expensive to defend, a reality that can act as a deterrent in some communities.

The fight against tobacco has also been difficult, Gortmaker, but has seen success, which he traced to three things: ending television advertising, taxing tobacco, and banning smoking in public places.

“Those three things really changed the landscape in America,” Gortmaker said, “and I think you can draw a direct analogy to what we can do with sweetened beverages.”

Food Loss, Waste, and Donation in India: Travel Notes from Two Student Clinicians

This blog post was written by FLPC students Taylor Dodson and Kelley McGill.

As part of the ongoing Global Food Donation Policy Atlas Project, we had the opportunity to travel to India over J-term with the Harvard Law School Food Law and Policy Clinic (FLPC) for hands-on research regarding laws, policies, and processes surrounding food donation in the country. On this trip, we had the opportunity to learn about exciting initiatives to reduce hunger and food waste in India, as well as to meet with a diverse group of food donors, food recovery organizations, and other stakeholders operating in Bengaluru, New Delhi, and Mumbai. Unlike in many other countries, most food recovery organizations in India handle prepared foods. These organizations manage recovery of surplus food from cooked meals instead of the fresh produce or pre-packaged products intended for retail typically donated in the U.S. This unique food recovery landscape in India is being met with the innovations of recovery organizations and other stakeholders independently motivated to tackle both food insecurity and food waste.

While traveling, FLPC met with Feeding India, a nonprofit aiming to mitigate hunger by utilizing an extensive network of volunteers (over 25,000 volunteers in over 104 cities!). These volunteers, or “Hunger Heroes,” are notified when a significant amount of surplus cooked food becomes available from individuals, restaurants, corporate offices, large cafeterias, or events. Surplus food pick-ups might be set at a regular and consistent time; for example, we visited a student dormitory at the Indian Institute of Technology Bombay. Here, cafeteria management has coordinated with Feeding India to pick up surplus food daily at the end of lunchtime. The food is first inspected and tested via temperature and sensory checks for quality and safety, transported in temperature controlled vehicles, inspected again, and then distributed to beneficiaries in need of regular access to food. Feeding India might also be notified of unanticipated surplus available after a wedding or event. No matter the situation, Feeding India volunteers quickly mobilize.

We also met with businesses that regularly engage in, or otherwise support, food donation. While much of the food donated in India is prepared or cooked food, rather than pre-packaged food, some companies donate a mix of the two types. One corporation we met with donates its unsold prepared meals on a daily basis. The foods that the company most commonly donates are a hybrid of pre-packaged and prepared foods, including meals such as pizza, sandwiches, and rice and beans. These foods, have all been freshly prepared each day in a central kitchen, then branded and individually packaged for sale, have shorter shelf lives than typical packaged food. To ensure that the meals are as fresh as possible when they reach recipients, Feeding India has regularly scheduled pick-ups at each one of the chain’s participating convenience stores. Unfortunately, there are not yet any financial incentives encouraging food donation in India, so donors like this corporation must be intrinsically and altruistically motivated.

While in India, we were also fortunate to meet with the government agency responsible for regulating food safety: the Food Safety and Standards Authority of India (FSSAI). This agency, in operation since 2011 and housed in the Ministry of Health & Family Welfare in New Delhi, enforces the Food Safety and Standards Act of 2006. In 2019, FSSAI published the Food Safety and Standards (Recovery and Distribution of Surplus Food) Regulations.[1] These regulations outline safety parameters for food donation and are a positive step towards encouraging the donation of safe, nutritious food. FLPC was impressed to see a national food safety agency such as FSSAI taking leadership and providing guidance to food donors.

Over the course of the trip, we learned a great deal about food recovery efforts in the beautiful, large, and incredibly diverse country that is India, and we are excited to watch these efforts expand even further over time.

[1] Food Safety and Standards (Recovery and Distribution of Surplus Food) Regulations, 2019, Gazette of India, pt. III sec. 4 (Jul. 26, 2019).

The views reflected in this blog are those of the individual authors and do not necessarily represent those of the Center for Health Law & Policy Innovation or Harvard Law School. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.

Can the U.S. Slash Food Waste in Half in the Next Ten Years?

Originally published on February 14, 2020 by The Revelator. Written by Tim Lydon.

Emerging efforts by cities and the federal government show that progress is possible, but experts say systemic changes are still needed.

Can the United States make progress on its food-waste problems? Cities like San Francisco — and a growing list of actions by the federal government — show that it’s possible.

San Francisco passed the nation’s first mandatory composting law a little over 10 years ago, requiring residents and businesses to separate food waste for municipal trash collection. The city, which already had an enormously successful recycling program, incentivized composting through consumer education, a scalable fee structure and, as a last resort, penalties. It also streamlined its entire waste collection system by contracting with a single waste hauler. That company, in turn, now delivers food waste to a composting facility that converts it to rich fertilizer, which is sold to California’s vineyards and farms at a profit.

The result? Composting has helped San Francisco reduce its annual waste by a whopping 80%, taken pressure off local landfills, and reduced the city’s greenhouse gas emissions. And the city is now a global leader in municipal-waste reduction.

San Francisco’s success has inspired other local governments to take similar action. In recent years a dozen other cities and states have adopted their own mandatory composting laws. Although it’s still a growing movement nationally, experts say this composting shift represents an important way that the United States can tackle food waste.

Every year American consumers and businesses waste hundreds of millions of pounds of food. The EPA estimates that about 22% of the foods we produce end up in landfills, with another 22% burned for energy. This contributes to climate change and a host of other environmental and humanitarian issues.

Congress agrees on the national value of community composting as one element of solving this problem. The 2018 Farm Bill, which passed a little over a year ago, created a fund for new composting programs.

It was one part of an unprecedented suite of actions in the Farm Bill designed to curb U.S. food waste. The actions encourage systemic change in the country’s food system and support an ambitious government goal to slash domestic food waste by half in the next decade.

The Obama administration established that goal in 2015, and it continues today under the Trump administration. It mirrors a United Nations goal to halve food waste globally by 2030.

In the United States, the broader effort is spearheaded by the EPA and the Department of Agriculture. With help from the Farm Bill, the country now seems poised to bring about meaningful change.

However, experts caution that continued progress will depend on continued support from Congress and solid commitments from industry, government, nonprofits and even consumers.

The Promise of Reducing Waste

No matter which way you slice it, food waste is a significant issue. In the United States, up to 40% of all food is tossed in the garbage. It’s more than just the uneaten food you scrape off your plate. Food waste happens at every stage of production, from vegetables rotting on the vine to dumpsters full of unsold fruit and meat at your local grocery store.

“Our food system is operating with a 40% inefficiency,” says Katy Franklin, operations director for the nonprofit ReFED, a leading resource for food-waste research, data and solutions design. The organization works in support of both U.S. and UN waste goals.

It comes with a huge cost for the climate: This waste represents an enormous use of fossil fuel to grow, ship and refrigerate food that no one will ever eat. And as food products decompose, they release methane, a greenhouse gas with many times the heat-trapping potential of carbon dioxide. Nearly all discarded food in the U.S. ends up in landfills, where it produces up to 14% of our country’s methane emissions.

Looking at production, distribution and disposal, the United Nations estimates that excess wasted food generates a full 8% of worldwide global carbon emissions.

If food waste were a country, it would be the world’s third-largest greenhouse gas emitter after China and the United States.

And the waste contributes to a host of other problems, including deforestation, pollution from fertilizers and pesticides, and human-rights issues from forced labor or food inequality.

But recognizing that problem also creates the opportunities for improvement. Tackling food waste, Franklin points out, “can be a huge part of reducing greenhouse gas emissions” and solving other problems.

Franklin and others see a lot of reasons for optimism, especially the 2018 Farm Bill, the most important elements of which are just starting to take effect. Top food-waste experts at ReFED and the Harvard Law School’s Food Law and Policy Clinic collaborated on recommendations for the bill, which were mostly accepted by Congress.

“It was satisfying and really thrilling to see the bill provide both funding and intellectual investment in the issue,” says Franklin. “That’s a magical combination.”

The Farm Bill Creates Leadership

While the Farm Bill put a range of programs in motion, three specific elements showcase the systemic changes needed to achieve serious cuts in food waste.

First, the law set the stage for the creation of a high-level “food-waste liaison” under the Secretary of Agriculture, with specific duties for researching and cutting waste. Franklin calls the new position an exciting signal of government leadership, which can help galvanize participation throughout the business, consumer and government sectors. While the 2018 Farm Bill did not pay for this new position, preliminary funding was included in the 2020 appropriations bill that passed in December 2019. The provision was inserted in both bills by Rep. Chellie Pingree (D-Maine), who in 2018 also launched Congress’ first-ever Bipartisan Food Recovery Caucus and has introduced other bills to curb food waste.

Until the liaison is hired, many of the duties assigned to the position by the Farm Bill fall to Elise Golan, the USDA’s director for sustainable development. She describes the role as a natural fit for USDA because reducing food waste addresses the department’s focus areas, including agriculture, nutrition, food safety and the environment.

Golan’s office is presently determining the best methods to define and measure U.S. food waste, an early task the Farm Bill laid out for the liaison.

“We need benchmarks to generate good statistics,” she says, “but even more importantly they help us identify the drivers of waste at every level, from farms to consumers.”

Although some broad national estimates exist, experts say a lack of more specific data limits the ability to track progress in reducing waste across the entire food system. A 2019 Government Accountability Office report reached similar conclusions. The report identified specific data gaps and pointed to inconsistent methods for measuring food waste among government agencies and others as a barrier to progress.

Golan says part of solving that problem requires greater coordination among federal agencies, another liaison role described by the Farm Bill. As an example of headway toward the goal, she points to an interagency strategy signed in 2019 by EPA, USDA and the Food and Drug Administration, which includes a commitment to improving food-waste measurement.

Other roles the liaison may eventually take on, as dictated in the Farm Bill, include raising public awareness, expanding existing programs, and nurturing both governmental and non-governmental partnerships, broad roles that experts say are best served by federal leadership.

Feeding the Hungry

In the second effort at establishing systemic change, the Farm Bill set the stage for removing hurdles that commonly prevent supermarkets, restaurants and farmers from donating unwanted food to charity.

According to the nonprofit Feeding America and other experts, food donations carry enormous potential for reducing waste while helping people in need. But getting companies to donate goods has been a problem. Surveys have shown that many retailers avoid donating surplus food because they fear potential lawsuits over less-than-optimal foodstuffs, even though they’d theoretically be protected by so-called “good Samaritan” laws.

The Farm Bill took steps to fix that problem by clarifying protections established more than two decades ago under the 1996 Bill Emerson Good Samaritan Food Donation Act. The Act previously offered liability to individual donors, nonprofits and “gleaners” — people who gather excess food left behind on agricultural fields. The new bill expanded that liability protection to cover direct donations by retailers.

The Farm Bill also required whoever eventually takes on the food-waste liaison role to publish additional guidance on the Bill Emerson Act, something no agency has done in the decades since the law’s passage.

Experts say weeding out this confusion around liability protections can spur growth in commercial food donations. Toward that end, the Farm Bill also authorizes millions of dollars to help farmers participate in donation programs, especially for the perishables that comprise a high percentage of U.S. food waste. As one of the first examples, this September the USDA rolled out a new program that reimburses farmers for milk donated to low-income families.

More Composting

The third example from the Farm Bill is a new fund to support community composting programs, which provides a total of $25 million to jumpstart pilot efforts in at least ten states.

Franklin and others call this provision especially important.

“There are so many valuable components of food-waste material,” says Franklin. “There’s really no reason they shouldn’t be part of a circular economy that helps produce energy, soil and other products.”

That’s just what San Francisco’s mandatory composting law has done, while also alleviating the burden on landfills and sharply cutting heat-trapping methane emissions.

There’s an economic benefit, too, says Franklin. Recycling food often creates more jobs than tossing it. That point holds true in Massachusetts, where recycling food waste supported over 900 jobs and $175 million in economic activity in 2016 alone, according to a recent report from the state government.

The three Farm Bill examples track well with a “food recovery hierarchy” developed by the EPA and others to guide thinking on food waste. It emphasizes that communities address waste prevention as their top priority, then move through a series of other solutions that include donating, repurposing and composting food, all before the least desirable practice of dumping it in a landfill.

Beyond the Farm Bill

Congress and government agencies are far from the only ones working on food waste. If anything, they’re late arrivals in a field where conservation and humanitarian groups have been toiling for years. They include the Natural Resources Defense Council (NRDC), ReFED, Harvard Food Law and Policy Clinic, Feeding America and many others, as well as hundreds of local food rescue groups that connect unwanted food with people in need. In fact, the Farm Bill provisions reflect many of these organizations’ longstanding recommendations.

The groups have helped spur the food industry into action. For example, large retailers such as Walmart began efforts to standardize food expiration labels after a 2013 report by NRDC and the Harvard Food Law and Policy Clinic showed confusion over the labels leads up to 90% of Americans to toss perfectly good food. In 2017 they were joined by industry associations representing dozens of major firms, who volunteered to trim the more than ten date labels — including “best by,” “sell by,” and “expires on” — to just two: “best if used by” and “use by.”

The Food and Drug Administration approved their choice of “best if used by” to indicate optimal quality this past May but stopped short of sanctioning “use by” as a marker for when an item could be safely consumed.

Still, ReFED and others point out that voluntary industry efforts are not enough. They say a continuing mishmash of retailer approaches and state food safety laws have prevented the universal standardization of labels. That standardization, they say, is only achievable by federal legislation that includes oversight, comprehensive consumer education, and consistency between state and federal laws. That may still emerge: In 2019 Rep. Pingree of Maine introduced label reform legislation that matches ReFED’s recommendations.

But as label reform shows, major industry players are coming to the table to help fight food waste. The EPA and USDA encourage their efforts through the 2030 Food Waste Champions program, which highlights companies working toward the government’s 2030 goal. Members include Walmart, Campbells, Kellogg, Kroger and more than 20 other large retailers. Although the program is voluntary and doesn’t require independent verification, highlighting again the need for better overall measurement standards, supporters argue it incentivizes companies to reduce waste.

“We’ve been lucky,” says Franklin, “because reducing food waste has a lot of appeal among businesses right now.”

But as Franklin says, unexpected events or market shifts could temper efforts at any time. She also points to the need for greater consumer education, as she’s regularly reminded that most people remain unaware of the food-waste problem.

But she sees promising work there, too, and highlights the World Wildlife Fund’s Food Waste Warrior toolkit for school teachers. Similar experiential education is also included in a bill Rep. Pingree and others introduced in January, which would initiate a new federally supported food-waste program in schools.

Taken together, all of these examples show legislators, agencies, nonprofits and industry collaborating to tackle food waste, with growing coordination around the government’s 2030 goal. Experts say such coordination is necessary for solving America’s — and the world’s — food-waste problem.

Ultimately consumer behaviors also need to change, but once again we can look to San Francisco for proof that this can work. Once the city government and industry put in place tools and incentives, consumer behaviors followed.

Franklin calls it a matter of fitting all the puzzle pieces together — and it’s almost like assembling a recipe to reduce food waste.

Experts agree we’re still a long way from meeting our 2030 goal, and caution that the years ahead will show if continued coordination and investment keep us moving forward, but they also say the hunger for solutions is another sign of progress.


Can opening more grocery stores reduce food waste?

Originally published on February 6, 2020 by The Counter. Written by Jessica Fu.

A new economic model suggests increasing geographic access to supermarkets could lead to more frequent shopping trips, and thus, less uneaten and spoiled food.

This July, Vermont will become the first state to completely ban food waste from its landfills—a move expected to divert tens of thousands of tons of methane-producing trash toward greener purposes, such as compost and feed for animals. Cities like Seattle and San Francisco already have similar mandatory food recycling laws in place, while other states like California and New Jersey have established food waste reduction goals. In 2015, the United Nations set the goal of halving global food waste by 2030, a target to which the U.S. has committed. All this is to say that the issue of food waste—though notoriously difficult to quantify with precision—has gained urgency among policymakers in recent years.

By and large, however, most mitigation efforts aim to provide people and businesses with alternatives to landfill, such as curbside compost pick-up or dedicated bins at restaurants for leftovers. But what if we could reorganize the food system in a way that reduces the amount of food that goes uneaten in the first place? New research suggests that we could do so by increasing grocery store density in cities.

A new study published in the peer-reviewed Manufacturing & Service Operations Management journal argues that increasing a neighborhood’s proximity to supermarkets would encourage its residents to shop more frequently, while purchasing less food each trip. Down the line, this would mitigate the high rate of spoilage resulting from buying bulk quantities of perishable food in one go. The tradeoff? More stores servicing smaller areas would also lead to increased retail-level food waste. That’s because individual businesses would find it harder to predict and stock the food that fewer customers want on a day-to-day basis. Nonetheless, up until a certain point—the study calls it the “optimal” density of stores in a neighborhood—the amount of food waste saved within households would still exceed the amount incurred at the business level.

“Actual store density in most American cities is well below this optimal level, and modest increases in store density substantially reduce waste,” reads the paper, authored by Elena Belavina, associate professor of operations management at Cornell University. To boot: Increased store density would increase competition and likely drive down prices. “Store operators, urban planners, and decision makers should aim to increase store densities to make grocery shopping more affordable and sustainable.”

Belavina’s findings are based on an economic model she designed using a wide range of interconnected data—store density, population, consumption rates, food prices, and more in cities throughout the country—reported by a variety of sources including the Census Bureau, the grocery industry, and prior research on food waste.

Belavina came up with the study’s central hypothesis while reflecting on changes she’d observed in her personal life. In 2012, she moved from the suburbs of Paris, France—where she shopped at a market near her apartment every day—to Chicago, Illinois—where she needed a car to get to the grocery store and made the trek at most once a week. In the Windy City, she says she threw away much more uneaten food.

“I started thinking, ‘That’s very interesting. I’m the same person, I’m buying the same groceries, but now just because of how convenient [grocery shopping] is for me, I’ve changed how much I’m wasting,’” she recalls.

This dilemma may feel intimately familiar to anyone who lives far from an affordable grocery store: Each shopping trip results in an overabundance of food at first, yet a disappointing proportion always seems to go bad before you get a chance to eat it.

The connection is a unique take on the persistent issue, and one that feels rather intuitive if you think about it.

“Often the biggest reasons people waste at home is poor planning,” says Emily Broad Leib, director of the Harvard Food Law and Policy Clinic. “Being able to purchase food, especially perishable food, on a more as-needed basis—logically it makes a lot of sense that that would help people waste less food.”

Belavina notes that increased grocery store density particularly benefits cities, which have the high population density needed to meet increased store supply. That means incentives to open more stores in New York City will probably play out differently than in, say, Yonkers.

The same could be said about any other food waste policies. In 2015, Vermont mandated that all trash haulers provide pickup services for food scraps and recyclables in addition to waste. But after residents raised concerns about the efficacy of such a requirement in rural areas compared to cities, the state loosenedthis restriction to apply only to haulers for businesses and multi-unit apartments.

“Compost programs around densely populated, more urban areas is probably going to be a win-win for a lot of situations in the sense that for haulers, there’s more people—which makes it potentially more cost efficient and fuel efficient as well,” says Meredith Niles, an assistant professor of food systems at the University of Vermont. “But the application of these kinds of policies in smaller towns and rural states might look very different.”

The connection between store density and food waste is an emerging area of interest. Last year, economists at the University of Georgia found that Mississippi counties with higher grocery store density produced less waste.

“It is possible that the ability to make short, frequent trips to buy groceries shortens the planning horizon with regard to meal preparation,” they theorized. That being said, proximity to grocery stores isn’t always the dominant factor determining where we shop, says Roni Neff, an associate professor at John Hopkins University and director of its food system sustainability and public health program.

“Consumers don’t necessarily shop at the store that’s close to their home,” she says. “They may travel for many reasons, including maybe something is near to where they work or on their transit route [….] Many people will go to what store has the best bargains or a great atmosphere. There’s a lot of intervening factors and we’re not really rational creatures.”

She’s pointing out a limitation to Belavina’s findings that applies to all economic models: They serve a useful purpose in simulating how you or I would probably behave under hypothetical circumstances, but they’re inherently limited in what they can prescribe at a policy level. Belavina notes as much in the paper, which encourages further, evidence-based research into the relationship between supermarket density and food waste.

“People are finding all these different, new, and interesting angles [to study food waste],” Neff says. “I think this is one of them that really needs to be followed up.”

Montana drops roadblocks to hepatitis C cure after years of pushback

Originally published on February 9, 2020 by Bozeman Daily Chronicle. Written by Katheryn Houghton.

Since a steady cure for hepatitis C has existed, Montana denied people on Medicaid access to treatment until the disease severely damaged their liver. This week, the state lifted that restriction among others citing lower prices for the care.

Health providers and advocates celebrated the change that went in place Feb. 3, though they say it came late.

“Montana’s discriminatory restrictions were standing in the way of eliminating hepatitis C,” said Robert Greenwald, a professor at Harvard Law School and the director of the Center For Health Law and Policy Innovation.

Before this week, Medicaid participants had three rules to get past before getting treatment: patients had to demonstrate severe liver damage, had to be sober from alcohol and drugs for six months and needed a specialist.

Montana had a heftier list of restrictions than most states. It was one of four that required patients to develop an active lung disease before getting care.

Because of its rules, last year the state’s Medicaid program denied treatment to 362 Montanans diagnosed with hepatitis C.

From 2017 through 2019, the state turned down 887 requests for the cure.

The overwhelming majority were denied because they weren’t deemed sick enough, said Marie Matthews, the branch manager for Montana’s Medicaid and Health Services

The restrictions came down to money.

“It was the cost of drugs,” Matthews said. “We’ve been talking to health care providers across the state for a long time about what could we do to make this benefit better. Thankfully, we are in a position this year to be able to afford changing the whole layout of the landscape.”

For a long time, people diagnosed with hepatitis C weren’t guaranteed a cure. In 2013, medication came on the market that meant a pill a day for 12 weeks could rid someone of the disease.

But it was expensive.

The initial sale price was roughly $90,000. Today, treatment costs closer to $24,000.

Because of the drop in price, Department of Health and Human Service spokesperson Jon Ebelt said, the department will be able to treat three-to-four times the number of people for the same cost compared to three years ago.

The argument of cost never lined up for some.

Organizations like National Viral Hepatitis Roundtable cite the price of caring for someone with the disease over a lifetime as medical bills stack up compared to 12 weeks of medication.

Greenwald, with Harvard Law School, is among those who called Montana’s old rules illegal, citing the treatment as essential medical care.

“We don’t deny access to health care for a person with diabetes because they don’t have a healthy lifestyle,” Greenwald said. “We don’t restrict treatment to cancer.”

In 2015, the Centers for Medicare and Medicaid notified states that restrictions like those found in Montana seemed to contradict federal coverage requirements.

The next year, Washington state was sued for rules that mirrored Montana’s. That came after a patient’s disease progressed past being able to get treatment as they waited to meet the state’s threshold for care.

A federal judge required the state to drop those restrictions, saying Washington needed to line up with national medical standards.

The Montana Department of Health and Human Services declined to comment on whether the restrictions had been illegal. Matthews said the state found money in its Medicaid budget to drop its rules as soon as possible.

“The disease is terrible,” she said. “We have drugs available to cure it and there are clearly better benefit plan designs than Montana had. All of these things helped raise this particular ask to the top.”

Dr. Ray Geyer, an infectious disease specialist based in Great Falls who advocated dropping the restrictions for years, said doctors were watching the debate over treatment access play out.

“We realized other state Medicaid programs had been sued by patient advocacy groups that resulted in a win, but did we want to do that in Montana? We kept adding pressure with that as a last resort and I think the state got it,” Geyer said.

People with low incomes are disproportionately affected by the disease. Geyer said more than 80% of his patients diagnosed with hepatitis C were covered through Medicaid.

He said at times he was able to find a loophole to get patients care by recording two state denials before taking that paperwork to a pharmaceutical company to try and get the medication for free.

But Geyer said last year the companies announced that would no longer be an option as the majority of state Medicaid programs operated without restrictions.

“I often had to explain to people, ‘You will get through this, it’s a 100% cure rate,’” Geyer said. “‘The only obstacle is the cost of your medication and who is going to pay for it.’ That gets people’s attention.”

Dr. Mark Winton, a Bozeman Health Deaconess Hospital infectious disease specialist, said the state’s 2016 Medicaid expansion meant the hospital saw an influx of patients testing positive for the disease as more people tapped into care.

Since it’s a slow-moving illness, he said some patients had to return for tests each year to see if their liver was damaged enough to begin care.

Meanwhile, the state estimates roughly 1,000 Montanans are diagnosed with hepatitis C a year. Winton said with the restrictions gone, Montana has a chance to chip at that statistic.

However, providers and advocates say Montana’s delay points to a bigger question: As medicine evolves, will governments and health care coverage continue to leave some behind.

“That’s part of the equation that we talk about all the time,” Winton said. “There’s no good answer yet.”

As of Friday, 38 Medicaid members in Montana had requested hepatitis C treatment since Feb. 3.

Food Loss, Waste, and Donation in Peru: Travel Notes from a Student Clinician

This blog post was written by FLPC advanced clinic student Nomin-Erdene Jagdagdorj, JD Candidate 2021

When fellow FLPC student clinician, Jordan, and I landed in Lima, Peru for our Global Food Donation Policy Atlas site visit, we didn’t know exactly what to expect; but that didn’t stop us from having high expectations. As it turned out, our positive anticipation was warranted: over the course of the next four days, we had the opportunity to meet with high-level members of government, grocers, wholesalers, and other stakeholders, all of whom are actively working to promote food donation in Peru.

One of the highlights of the visit was our early morning trek to the wholesale produce market to see food donation in action. Banco de Alimentos del Perú (BAP), with support from Global Foodbanking Network (GFN), recently launched a new program at the market, one which promotes the recovery of surplus fruits and vegetables that are fresh, nutritious, and safe for human consumption. The operation at the wholesale produce market is a major supporter of food security in Lima, but it is also a driver of food waste. Without BAP’s rescue efforts, surplus produce is tossed in the garbage and sent to the landfill to make room for the next day’s offerings.

As we walked around this major supply source food (and food waste), a few aspects struck us as particularly noteworthy:

First—the scale. The market featured several warehouses, each designated for one or two individual vegetables, and divided into dozens of stalls. Piles of sweet potatoes, onions, tomatoes, purple corn, garlic, yucca, pepper filled each stall. With such massive quantities and so many vendors, finding sufficient demand for the supply seemed impossible. It was therefore easy to see the importance of BAP’s surplus recovery operation. Even so, BAP volunteers were able to rescue only a tiny percentage of the surplus produce that is still safe for human consumption. The rest of the unsold product would be discarded into waste bins by the end of the day. 

Second —the donors. Starting at midnight, waves of restaurateurs and smaller produce markets had journeyed to the market to stock up on produce. By the time we arrived around 9am, vendors had already started to close down their stalls. Lucky for us, several of BAP’s most regular donors were still around, and we were able to learn about how important it is for many of them to donate their surplus rather than throw it away. Several vendors we interviewed were also producers and did not want to see their hard-earned products simply thrown in the trash because there wasn’t an interested customer. Many vendors went out of their way to make sure that BAP came to pick their leftover produce up multiple times each day, even though it would have been easier to throw away the produce in the trash bins sitting in every aisle. It was refreshing to see that, even when throwing food away seems like the simplest option, people are willing to take the initiative and the time to donate.

Finally, the best surprise—the potential for BAP’s operations at the market to continue its exponential growth. Since July of 2019, when BAP first started recovering produce at the wholesale market, the monthly recovery yield had increased from 20-30 tons to over 127 tons in December alone. BAP had already recovered 32 tons in the first eight days of 2020, even with slow donations through the holidays. Each day, members from five or more charities came to pick up the produce that BAP recovered from the market’s vendors. These charities would transport the food back to their facilities where the food would directly benefit those in need. With no shortage of food surplus as the market, and high rates of food insecurity among Peruvians, we realized that there was tremendous potential for this operation to grow. To make the most of this recovery effort, however, BAP and receiving charities will need much greater operational and financial support.

Seeing the scale of produce available at the market, the willingness of many vendors to donate, and the potential for BAP’s operations to grow were research points we couldn’t have collected in Cambridge. Vendors’ historical practice and continued ease of putting surplus into trash bins remains an obstacle for BAP’s rescue efforts, especially as BAP has limited on-the-ground support and depends entirely on volunteers. Even so, the model at the wholesale market was an impactful example of how food recovery organizations can help redirect fresh, nutritious produce from landfills to those who need it most.

We are so grateful to our food banking partners at BAP and GFN for making our site visit to Peru so informative and meaningful!

The views reflected in this blog are those of the individual authors and do not necessarily represent those of the Center for Health Law & Policy Innovation or Harvard Law School. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.