A U.S. National Food Strategy to Address Long-standing Food System Challenges

The coronavirus pandemic exposed major long-standing problems in the U.S. food system. Harvard and Vermont Law Schools’ “Urgent Call for a U.S. National Food Strategy: An Update to the Blueprint” identifies a framework to create more effective and coordinated policy solutions.  


The COVID-19 pandemic brought the U.S. food system to the brink of catastrophic collapse, but the problems exposed were present long before the coronavirus arrived in the United States. 

For years, food policy experts have warned of a crisis in the nation’s food system, which is riddled with weaknesses, inefficiencies, and injustices and suffers from an arcane and fragmented regulatory regime. Government shutdowns and the public health impacts of COVID-19 exacerbated and turned a spotlight on many long-standing problems. 

“The major food system challenges made so obvious by COVID-19—soaring rates of food insecurity, disproportionate impacts to underserved and BIPOC communities, inadequately protected food system workers, staggering amounts of lost income for farmers, and enormous food waste—already existed before the pandemic at crisis levels, “ said Laurie Beyranevand, Director of the Center for Agriculture and Food Systems and Professor of Law at Vermont Law School. “These injustices and failures persist because we lack formal structures for coordination making federal solutions piecemeal, incremental and responsive, rather than comprehensive, strategic, and proactive.” 

A national food strategy would provide a framework to identify and address these shortcomings and encourage a transition to a more just, fair, efficient, and economically-resilient food system. 

Today, Vermont Law School’s Center for Agriculture and Food Systems (CAFS) and Harvard Law School’s Food Law and Policy Clinic (FLPC) released “The Urgent Call for a U.S. National Food Strategy: An Update to the Blueprint.” Given the worsening challenges facing the food system—current threats like the COVID-19 pandemic and long term threats like climate change— CAFS and FLPC advocate for a coordinated approach to policymaking that helps identify our national food system priorities and provides opportunities for stakeholders and the public to give feedback on how to navigate the tradeoffs inherent in food policymaking. 

The United States currently lacks a mechanism to address the interconnected economic, health, environmental, and equity issues inherent in the food system. Instead, the American food system is governed by a poorly-coordinated patchwork of federal, state, tribal, and local laws, administered by agencies with overlapping duties that result in inefficiencies and yield unintended consequences. A coordinated strategy at the federal level would streamline food system policy.

“If we are going to solve the issues plaguing our food system, we will need commitment and coordination from all levels and branches of government, and participation from a diverse range of stakeholders, including farm and food system workers, advocates that regularly address food insecurity and environmental issues, and the general public,” said Emily Broad Leib, Faculty Director of FLPC and Clinical Professor of Law at Harvard Law School.  “We have seen this sort of cohesive national action before with the response to 9/11 and with the National Strategy for HIV/AIDS. The COVID-19 pandemic has unearthed a food crisis that merits a similar response, a response that will also work to address long-standing inequities in our food system well beyond the current crises,” Broad Leib concluded.

The new report builds on the Blueprint for a National Food Strategy, a roadmap for how the federal government can and should develop a U.S. national food strategy, published by FLPC and CAFS in 2017. Since then, some federal agencies have taken incremental steps to coordinate on discrete food system issues, but no initiative has led to a comprehensive strategy for coordinating policies that impact the food system.  

The Urgent Call for a U.S. National Food Strategy: An Update to the Blueprint revisits other national strategies that provide guidance and concrete examples for building a national food strategy. It provides updates on food strategies in those countries, including an accelerated approach in the United Kingdom, and the launch of a new coordinated national food policy in Canada. The updated report also examines the stresses put on the U.S. food system by the coronavirus pandemic, emphasizing how the government’s fragmented and delayed response reflects the ongoing problems related to uncoordinated food system planning and policymaking. 

The report recommends that a national food strategy incorporate the following principles:

  1. Leadership and interagency coordination to draft and implement the strategy.
  2. Participation from state and local governments and a diverse range of stakeholders.
  3. Transparency, accountability, and enforceability in the national food strategy drafting and implementation.
  4. Durability to maintain focus on long-term priorities and withstand changes in the presidential administration and Congress.

The full report can be viewed at http://foodstrategyblueprint.org.

Why a National Food Strategy?

Title of report with picture of farm in background.The Harvard Law School Food Law and Policy Clinic (FLPC) and Vermont Law School Center for Agriculture and Food Systems (CAFS) released The Urgent Call for a U.S. National Food Strategy. Because of its enormous impact on the United States’ economy, public health, and environment, a thriving food and agricultural system (“food system”) is critical to our nation’s wellbeing. Unfortunately, the current food system faces severe challenges. Diet-related disease—which includes obesity, heart disease, stroke, type 2 diabetes, hypertension, and various cancers—is the most significant public health challenge facing the United States, and disease rates are rising precipitously. For example, nearly ten percent of Americans suffer from diabetes today (and more than one-third are pre-diabetic), compared with less than one percent fifty years ago. The food system devastates the environment by degrading soil, destroying biodiversity, and emitting greenhouse gases that threaten the Unites States’ long-term viability. The food system is also deeply inequitable, as Black, Indigenous and people of color (BIPOC) and under-resourced communities are disproportionately impacted by its negative economic, health, and environmental aspects, not only as consumers but also as farmworkers and other food system laborers. 

The Urgent Call for a U.S. National Food Strategy builds upon the 2017 Blueprint for a National Food Strategy, which called for the United States to develop a national food strategy and offered recommendations for a this coordinated federal strategy based on an analysis of selected domestic and international models. The Urgent Call continues to advocate for the adoption of the Blueprint’s recommended strategies, but it does so within a new context: the COVID-19 pandemic has made the need for a national food strategy even more urgent. Congress and the next presidential administration should use this pivotal moment to respond to the inequality, environmental damage, and poor health outcomes that plague the country’s food system.

COVID-19 and the Food System

If it was not already clear that the United States urgently needs a coordinated food strategy, the COVID-19 pandemic has exacerbated every difficulty the food system typically faces. Food insecurity sharply increased as the virus caused job loss and disrupted food distribution and donation channels, and BIPOC communities were hardest hit. Farmers and food producers were also harmed, when shutdowns in the foodservice sector led to wasted food and lost income. Though food supply chains are efficient, they are not necessarily resilient, and food meant for one market often could not be diverted to another due to packaging, labeling, and distribution challenges. 

In addition to causing food insecurity and waste, COVID-19 quickly spread through food system workers who, though quickly deemed “essential,” earn low wages, often work in hazardous conditions, and receive minimal job protection. Agricultural workers and workers in meatpacking facilities are especially vulnerable, as many of them are unauthorized immigrants and other marginalized populations, and are uncomfortable raising complaints about unsafe working conditions because of job security fears. The federal government’s treatment of these workers during the pandemic has been particularly egregious. The federal government did not release guidelines for COVID safety in meat and poultry processing facilities until the end of April, and did not release guidelines for agricultural workers until June. Even when these guidelines finally emerged, they were purely guidance, and not required or enforceable. Only recently did OSHA charge a few noncompliant meat processing plants with fines, and these fines were minimal despite clearly unsafe conditions.

Building a National Food Strategy

To address these food system problems, CAFS and FLPC recently released The Urgent Call for a U.S. National Food Strategy. This report expands on the 2017 Blueprint, reiterating why the United States needs a national strategy and describing what progress has been made toward that goal over the past few years.

Foreign governments have already mobilized to establish more cohesive food systems. Since 2017, the United Kingdom and Scotland have made progress toward their food system goals. Canada launched its own national food strategy in 2019, and provides a strong example of creative and collaborative food system innovation. Furthermore, in response to COVID, subnational governments have organized around food system change; New York City and Massachusetts devised particularly commendable relief plans.

Developing a secure and equitable food system will prove challenging, but it is well within the nation’s capabilities. The Urgent Call implores federal policymakers to quickly mobilize around the issue. Like the Blueprint, the The Urgent Call offers recommendations for creating a fair, sustainable, and inclusive national food strategy. It also analyzes examples of other times the American government has created coordinated strategies to address other urgent, complicated societal issues. Consider, for example, the Obama Administration’s creation of the National HIV/AIDS Strategy in 2010, which responded to sustained public support for a comprehensive response to the HIV/AIDS crisis, and Congress’s creation of the 9/11 Commission to address national security and terrorism concerns. 

Despite—indeed, because of—the havoc COVID has wreaked on our country’s food system, now is the time to make structural changes for the long-term security, sustainability, and health of the food system. The importance of this moment is even greater considering the upcoming 2020 election. The new Congress and next presidential administration should make the creation of a comprehensive national food strategy one of their first goals—the time has never been better.

How Trump success in ending Obamacare would kill Fauci plan to conquer HIV

Written by and published by The Guardian on October 23, 2020.


In his State of the Union address in February 2019, Donald Trump vowed to end the HIV epidemic by 2030.

But if Trump has his way and the supreme court strikes down the Affordable Care Act (ACA), the resulting seismic disruption to the healthcare system would end that dream.

Democrats have expressed grave concern that if Amy Coney Barrett is seated on the supreme court, the conservative jurist could cast a decisive vote to destroy the ACA in the California v Texas case scheduled for oral argument starting 10 November. The Senate judiciary committee committee voted to advance Barrett’s nomination on Thursday. A full Senate vote is expected on Monday.

The brainchild of Dr Anthony Fauci and other top brass at the Department of Health and Human Services, the ambitious Ending the HIV Epidemic: A Plan for America has received for its debut year $267m in new federal spending, largely targeted at HIV transmission hotspots across the US.

The central aim of the Trump-backed plan is to improve access to antiretrovirals, given that successfully treating HIV with such medications eliminates transmission risk. For HIV-negative people, the plan promotes greater use of PrEP – a daily antiretroviral tablet that cuts the risk of HIV by more than 99% among gay and bisexual men, who are its predominant users and account for seven in 10 new infections.

Given antiretrovirals’ enormous cost, the ACA and its broadening of insurance access serves as backbone to the HIV plan, which seeks a 90% reduction by 2030 to the otherwise slowly declining or stagnant national HIV transmission rate of about 37,000 new cases annually.

“The plan is dead in the water if the ACA goes down,” said Amy Killelea, senior director of health systems and policy at Nastad, an HIV public policy non-profit.

“President Trump’s healthcare agenda, in particular his plan to get the supreme court to rule against families’ healthcare, does more to end access to HIV care than it does to end HIV,” said the Washington state senator Patty Murray.

‘Heartbreaking and morally indefensible’

Kaiser found that between 2012 and 2018, the proportion of the non-elderly HIV population lacking insurance declined from about 18% to 11%. This shift was mainly driven by the expansion of Medicaid in the states that opted under the ACA to open the program to all residents with incomes below 138% of the federal poverty level.

About 60% of non-elderly people receiving care for HIV fall into that lowest of income brackets. Forty per cent of people with HIV receive Medicaid, compared with 15% of the general population.

“Striking down the ACA would lead many people with HIV to lose insurance coverage,” said Jennifer Kates, director of global health and HIV policy at the Kaiser Family Foundation.

Medicaid expansion has also been tied to increased HIV testing and PrEP use. In Louisiana, the only state in the deep south to expand Medicaid, state officials attributed a 12% decline in HIV diagnoses between 2015 and 2018 to such effects.

For an overall population as vulnerable and stigmatized as those living with and at risk for HIV – one that is disproportionately Black and Latino, with a high rate of substance use disorders, mental illness, homelessness, incarceration and especially during the Covid-19 pandemic, unemployment – a sudden loss of health insurance can prove critically disruptive to consistent healthcare engagement and access to antiretrovirals.

When individuals stop taking such medications, HIV can spread more widely as viral load rises to a transmissible level in people with the virus and HIV-negative people lose PrEP’s protection.

The pandemic has already disrupted such access. Preliminary analyses point to rising rates of unsuppressed HIV and major declines in PrEP refills and testing for the virus in recent months.

“In light of the extraordinary public health and economic challenges we are currently facing, the idea that the supreme court would reverse the great progress we have made in efforts to eliminate HIV in the United States is heartbreaking and morally reprehensible,” said Robert Greenwald, director of the Center for Health Law and Policy Innovation at Harvard Law School.

The federal Ryan White HIV/Aids Program and its $2.4bn budget will continue to provide uninsured people with HIV with at least some form of safety net, helping to cover care and treatment should Obamacare fall.

But since the ACA’s major insurance provisions launched in 2014, Ryan White has undergone a major shift, especially in Medicaid expansion states, toward focusing on covering ancillary “wraparound” services for insured people with HIV, such as case management, housing and transportation. The program also increasingly pays for private Obamacare plan premiums. These shifts, research indicates, have improved viral suppression rates.

Ryan White’s wraparound coverage would dissipate if funds were more urgently needed to address an insurance-loss surge. Kates and other experts predict the program might not prove nimble enough to promise a smooth transition into a post-ACA era.

Experts also fear a return of waiting lists for HIV treatment coverage by the Aids Drug Assistance Program, a Ryan White component that co-funds medication or health insurance premium coverage with the states. These notorious lists have tended to lengthen during economic downturns, thanks to tightening state budgets.

Decimating the ACA would also vaporize numerous less widely appreciated facets of the law that provide crucial protections for insured people living with and at risk for HIV. These include the elimination of annual and lifetime coverage caps, the establishment of annual caps on out-of-pocket costs, and the promise of no such costs for validated preventive services, such as HIV testing and PrEP. The law’s anti-discrimination provisions have also helped ensure more equitable healthcare access.

Trump’s claim he can simply forbid pre-existing condition exclusions by executive order notwithstanding, a loss of this cherished ACA-guaranteed protection would, Kaiser research indicates, render people with HIV uninsurable on the open market.

‘Ham-fisted’

The opioid crisis, which along with other forms of substance abuse has begun to reverse the two-decade decline in HIV diagnoses among people who inject drugs, is also poised to worsen if the nation loses ACA-based coverage for mental health and substance use disorder treatment in particular.

Greg Millett, director of public policy at amfAR, The Foundation for Aids Research, noted that during a year defined by urgent calls for racial justice, the harsh demographic realities of the intersecting Covid-19 and HIV epidemics serve as prime examples of the nation’s long failure to address race-based health inequities.

“It’s no mistake with this administration that they are not following the science comprehensively in addressing HIV, nor Covid-19,” Millett said. “And unfortunately, not following the science to address HIV or Covid-19 primarily impacts people of color.”

The Trump administration’s “ham-fisted” handling of Covid-19, Millett said, has already jeopardized achieving the goal of ending the HIV epidemic by 2030.

Michelle Collins-Ogle, a pediatric and adolescent HIV physician at Montefiore medical center in the Bronx, expressed outrage over conservatives’ dogged battle to destroy the signature legislative achievement of the Obama administration, the ACA.

“Here I am, working hard to take care of people who are indigent and vulnerable,” Collins-Ogle said. “And you want to take away from me the one tool I have to make sure that I do the best for these people?

“How dare you?”

North American Food Strategy

Originally published by Farm to Table Talk on October 17, 2020.


The North American food system has succeeded in producing an abundance of commodities at relatively low cost, but it is failing in other ways that matter. Showing how law and policy should make needed changes is the purpose of “the Blueprint for a National Food Strategy”.  This work in progress is a collaborative project between the Center for Agriculture and Food Systems at Vermont Law School and Harvard Law School Food Law and Policy Clinic.  Some of the project’s recommendations have already been accepted in Canada and  will be considered in the next US Farm Bill.  Harvard Law Professor Emily M. Broad Lieb, Director of the Food Law and Policy Clinic, focuses her scholarship, teaching, and practice on finding solutions to some of today’s biggest food law issues, aiming to increase access to healthy foods, eliminate food waste, and support sustainable food production and local and regional food systems.Professor Broad Lieb shares her journey from Harvard Law to rural Mississippi and back as food system success, shortcomings and solutions are addressed. www.foodstrategyblueprint.org

Click HERE to listen.

This is a once-in-a-lifetime opportunity for change

Originally by Erin Peterson and published by Harvard Law Today on October 20, 2020.


Three series of talks led by Harvard Law faculty are helping provide clarity on the topics that have driven this difficult year. Here, series organizers share the way this moment has affected their own thinking and research.


As a deadly global pandemic hit the U.S. early this year, disproportionately impacting marginalized groups and communities of color, and profound questions of racism, racial injustice, and abuse of power were again brought into sharp focus by the killing of George Floyd and other Black people across the nation, Harvard Law faculty saw more than just one of the most difficult seasons in American history. They saw the opportunity to step up and take action.

One of the major efforts that has come from this desire to do more is a trio of series led by Harvard Law faculty. The three series—“Racial Equality?,” “Policing in America,” and “COVID-19 and the Law”—launched in September and include colloquiums, student blogs, and an array of other resources. They will continue throughout the academic year.

For 300th Anniversary University Professor Martha Minow, a former dean of Harvard Law School who is co-organizing “COVID-19 and The Law” with Clinical Professor Emily Broad Leib ’08, these series represent exactly what the school should be doing right now. “At our best, we are always engaged in three levels of education: teaching students and preparing them for the world, developing research, and doing the hands-on service delivery that our clinics and research centers do,” Minow says.

She expects the series to be vital hubs for debate and knowledge exchange at a critical moment. “Everyone feels a sense of urgency and a sense of the importance of doing this work,” she says.

We asked the organizers of these series to share how these last months have influenced their work and thinking—and what might be next. Edited excerpts from longer conversations follow.

illustration

Credit: Anthony Russo

“The criminal justice system is not hermetically sealed off from our democracy. It’s central to how we understand big issues of American identity: of race, of community, of poverty, and many aspects of American history itself.” – Alexandra Natapoff

Policing in America

Professors Andrew Manuel Crespo ’08 and Alexandra Natapoff organized the “Policing in America” series. The discussions examine police practices, the possibilities for reforming the American penal system, and approaches to curbing abuses of state power.

Bulletin: George Floyd’s killing was a wake-up call for many. What should we make of the moment we’re in?

Crespo: This has the potential to be a historic moment of social reckoning. Sustained protests over policing have been one of the major defining features of the summer of 2020, which has a lot of competition for defining features. People who have studied or lived within the American penal system and experienced policing firsthand are aware of many of its deep problems. But twice in the past six years, these issues have erupted into a national conversation.

Natapoff: The criminal justice system is not hermetically sealed off from our democracy or other institutions within our democracy. It’s central to how we understand big issues of American identity: of race, of community, of poverty, and many aspects of American history itself.

You can’t understand courts without understanding prosecutors, and you can’t understand prosecutors without understanding police, and you can’t understand policing without understanding how policing practices intersect with other social organizations and social policies.

Crespo: One of the classes that I teach, Criminal Procedure, is about the law of policing. In part, it’s about how our law has, over a series of decades, not lived up to the task of regulating or constraining police behavior. It’s about how some of the problems that we see are predictable consequences of a long march in the constitutional law of policing. But the second major theme of the course is that we shouldn’t expect legal rules to be enough, in themselves, to address what are fundamentally deep societal issues and interconnected issues.

Bulletin: What happened in Ferguson and with George Floyd seems to suggest we deal with the same problems over and over. Are we making progress?

Crespo: Yes, some. To take one example, a small handful of prosecutors who have won political office in recent years are using their prosecutorial discretion—which drives so much of our penal system—in ways that are intended to be decarceral. They’re saying: There are certain behaviors that we will not treat as criminal matters, even if they might violate parts of the penal code. Instead, we’ll look for other solutions, rather than policing and prison, to deal with big social problems like poverty, mental illness, and drug addiction.

Natapoff: Fifteen years ago, people were still having arguments about whether mass incarceration was a good idea. Today, we aren’t arguing that prisons are the solution to public safety. People understand that mass incarceration carries with it a profoundly expensive, ineffectual and racist legacy.

How has that shaken out? We’ve seen a wave of decriminalization of marijuana offenses. We’re seeing bail reform all over the country, because people understand that locking people up because they can’t afford to pay is unjust. There’s been pushback against the use of fines and fees.

All of these incremental changes are cause for hope.

illustration

Credit: Anthony Russo

“The pandemic has jump-started what had been a slow process of using digital tools in the judicial system and for legal services for low-income people.” – Martha Minow

COVID-19 and The Law

This series covers a range of law and policy topics linked to COVID-19, including health law, election law, housing and food law, and access to justice and legal innovation. The topics are particularly focused on COVID-19’s impact on marginalized populations. The co-organizers are 300th Anniversary University Professor Martha Minow and Clinical Professor of Law Emily Broad Leib, founding director of the Harvard Law School Food Law and Policy Clinic.

Bulletin: How has COVID-19 had an impact on areas linked to your own research?

Minow: A long-term interest of mine is using digital technologies to close the gaps of access to justice. For example, if someone is facing eviction, does that person have to go into a court? Can the hearing be done online? Could there be available forms or even advice online? Could legal assistance be provided, by lawyers or others?

The pandemic has jump-started what had been a slow process of using digital tools in the judicial system and for legal services for low-income people. There’s much more openness to using these tools now and inventing new techniques. Still, major inequities remain.

Broad Leib: I focus on the food system, and there are many areas that have been affected. One is food security and food access. I’ve done a lot of work on school meals, and right now we have the complication of getting kids healthy meals when many schools are closed, and food insecurity has more than doubled. Cities and rural areas are doing their best to set up multiple pickup points, but these are all things that we worked on for years with individual school districts and state education departments. Almost overnight we had to rethink all the ways that they were procuring and distributing food.

But that’s just one thing. Food is a system, and you have to understand it from the seeds going into the ground all the way to the consumer. There’s also the challenges of supporting farmers and food producers, reducing food waste and getting food donated, and helping workers at every level of the food chain—agriculture workers, workers in meat and poultry processing, and grocery store workers, for example, who have suffered some of the highest infection rates. Every single aspect of that chain has been affected by COVID-19.

What could come out of this difficult time?

Broad Leib: Within my field, people have been sounding the alarm for years. It’s an overly consolidated system, it’s inequitable, and we waste up to 40% of the food we produce. But as a result of the pandemic, many things that used to be invisible to consumers are more visible.

I hope that this will bring attention to areas that need big overhauls. For example, I’ve been pushing for the United States to create a national food strategy: What do we want from our food system? Looking forward 10 or 20 years, how can we make it more sustainable, equitable and healthy?

We know that many national strategies in the United States come out of an emergency or disaster. This may be the catalyst we need to go back to the drawing board to invest in systems that meet the needs we have—and that is just within the food system. We know this crisis will also be a catalyst for change in many areas of law and policy, and our series aims to bring these topics up and into dialogue with one another.

Minow: In some ways, all assumptions are up for grabs.

For example, there has been resistance for years to having online applications for food stamps, and those restrictions were gone almost immediately. Could there be a thoughtful approach for debt forgiveness? Could we have some permanent adjustments of student loans or small-business loans?

Our speakers are rightly giving particular attention to problems and strategies related to the pandemic’s disproportionate impact on marginalized groups. This is a once-in-a-lifetime opportunity for change if we take advantage of it.

illustration

Credit: Anthony Russo

“Martin Luther King Jr. said that he’d been to the mountaintop and seen the promised land. What does it look like? … How will we know that we have reached the promised land of racial equality?” – Randall Kennedy

Racial Equality?

This series examines debates over the possibility of attaining racial equality and conceptions of equality over the course of American history. It is organized by HLS Professors Randall Kennedy and Annette Gordon-Reed ’84, who is also a professor of history at Harvard University. 

Bulletin: Can you tell me about that question mark in the title?

Kennedy: Everybody says they’re in favor of racial equality. But what does that mean? Martin Luther King Jr. said that he’d been to the mountaintop and seen the promised land. What does it look like? What is its topography and what are its boundaries? Are we getting closer to it? How will we know that we have reached the promised land of racial equality? What are competing conceptions of racial equality? These are some of the topics that are being addressed in this lecture series.

Gordon-Reed: We also know that there are differing definitions of racial equality. We wanted to have a series that gave students a chance to see a range of opinions about what racial equality means and how we will know when it has been achieved, if indeed it will be. 

How has George Floyd’s killing influenced the way that people think about racial equality?

Kennedy: Widespread protests against racist policing and other forms of racial injustice have put the matter of racial equality into the center of national discussion. A year ago, we would not be hearing the commissioner of the National Football League proclaiming that Black Lives Matter. A year ago we would not be witnessing Amazon and Bloomingdale’s embracing that slogan. But now they are, propelled in large part by the torrent of energy unleashed by dissidents committed to focusing public attention on the way that so many problems, from bad policing, to bad provision of medical care, to bad employment and housing policies, have an especially burdensome adverse effect upon historically oppressed racial minorities.

Gordon-Reed: His killing galvanized the world in a way that was surprising. I don’t know whether it was because so many people were sequestered at home because of the pandemic, and people had the chance to really look at what had happened. There have been videos of police killing Black people before, but this was deeply affecting people all over the world.

Does this increase in attentiveness to racial matters make you feel optimistic?

Kennedy: I’d put myself in the optimistic camp, but not with the confidence that I once had. I am an African American born in South Carolina in 1954, the year of Brown v. Board of Education. I saw the reforms of the Second Reconstruction pry open opportunities denied to my forebears. I thought that there were certain fundamental tenets of anti-racism that had been established and were beyond disputation. I thought that the country would never again be headed by an overtly racist president. I obviously erred and feel tremendously unsettled by my misjudgment. My angst and curiosity have fueled my desire to join with Professor Annette Gordon-Reed in organizing this series of lectures.

Gordon-Reed: Well, I prefer to be optimistic. This is a crazy time, a particularly crazy year, but seeing people all over the world marching under “Black Lives Matter” banners suggests that a critical mass of people have decided that things should change. That’s a critical first step—to get people to pay attention and begin to talk about the importance of confirming Black citizenship in the United States.

54 million people in America face food insecurity during the pandemic. It could have dire consequences for their health.

Originally written by Bridget Balch and posted on AAMC on October 15, 2020.


Physicians, researchers, and food policy experts highlight the need for accessible, healthy food to combat poor health in vulnerable populations.


When the Massachusetts General Hospital (MGH) Revere HealthCare Center opened its therapeutic food pantry in January 2020, the plan was to start off with a three-month, 10-patient pilot program. The pantry would provide plenty of plant-based, healthy food to the patients, all of whom had nutrition-dependent chronic diseases, like diabetes and obesity, and were food insecure, meaning they lacked enough food to live a healthy and active life.

“Of course, then COVID hit,” says Jacob Mirsky, MD, a primary care physician at MGH Revere and the food pantry’s medical director.

The number of community members in the Boston area struggling to access nutritious food jumped in March as the measures put in place to contain the novel coronavirus pandemic hit them economically. Mirsky and his team decided to rehaul the entire operation and expand service to every patient treated at the center and their families.

With funding from MGH Revere and partnerships with local food nonprofits, the pantry grew from operating out of a closet to filling a 1,000-square-foot storage space and feeding up to 80 patients and their families each week.

Food insecurity across the country has risen significantly since the pandemic sidelined 14 million workers in the United States from February to May, according to the Pew Research Center.

Feeding America, the largest hunger-relief organization in the United States, estimates that 17 million people in the country could become food insecure because of the pandemic, bringing the total to more than 54 million people in the country, including 18 million children. Before COVID-19, food insecurity was at its lowest since the Great Recession, but it still impacted 37 million people.

Since food insecurity and poor nutrition are associated with several chronic illnesses that put people at higher risk for the more severe complications of COVID-19, the food access crisis threatens to exacerbate the already glaring disparities in health outcomes for vulnerable people, including low-income people, children, older adults, and immigrants living in the United States illegally.

“Though the factors underlying racial and ethnic disparities in Covid-19 in the United States are multifaceted and complex, long-standing disparities in nutrition and obesity play a crucial role in the health inequities unfolding during the pandemic,” writes a cohort of physicians and researchers in an article published in the New England Journal of Medicine in September. “A healthy diet, rich in fruits and vegetables and low in sugar and calorie-dense processed foods, is essential to health. The ability to eat a healthy diet is largely determined by one’s access to affordable, healthy foods — a consequence of the conditions and environment in which one lives.”

Mirsky believes that it is incumbent upon the health care system, and particularly academic medical centers, to take on a greater role in educating and connecting patients to healthy and tasty foods — and consequently reduce the prevalence of nutrition-related illnesses.

“We’re now living in a world where it is abundantly clear that the power of doctors and medical students and trainees expands beyond the walls of a health care setting,” Mirsky says. “Building these types of solutions [that address social determinants of health] is just as important — if not more important — than prescribing them medicine.”

Food is medicine

Over the past decade, a growing body of research has linked poor nutrition to poor health outcomes, particularly in patients with chronic diseases such as heart disease and diabetes. This can stem from not only a lack of food but also an excess of unhealthy food that can cause obesity and contribute to other health problems. For many, this could be because they live in a food desert, where there are no grocery stores within a mile of their home, or because unhealthy food may be cheaper and easier to access.

The research has birthed a movement known as “Food is Medicine,” where physicians, nutrition experts, and policymakers encourage the use of programs that provide medically-tailored food to prevent and treat serious illnesses in patients, as opposed to relying solely on pharmaceuticals and other health care interventions.

“Food is really critically important for many of the diseases that are plaguing our country and the world,” Mirsky says.

A report published by the United States Department of Agriculture in 2017 found that food insecurity was associated with 10 of the costliest and most deadly preventable diseases in the country, including hypertension, diabetes, cancer, and stroke.

Conversely, a healthier diet, particularly one that focuses on plant-based meals, has been associated with reduced risk for several chronic diseases, depression, and decreased mental function.

Barriers to access

But for millions of people in the United States, eating enough nutritious food is far easier said than done. Certain groups living in the United States face additional barriers and risks when it comes to nutrition and health, particularly in the midst of the COVID-19 pandemic.

Children: Nearly 30 million children in the United States qualified for free or reduced-cost lunches at school in 2019. The COVID-19 pandemic has complicated food insecurity among children, as the estimated number of food-insecure kids could jump from 11 million to an estimated 18 million, according to Feeding America. While many schools have continued to provide meals to children in need and food banks and pantries have amped up services, the disruption could have concerning long-term consequences. Studies have linked food insecurity in children to poor health, stunted development, behavioral issues, and difficulty keeping up in school, according to Feeding America.

Older adults: Seniors, generally defined as people age 65 and older, are at increased risk of the more severe complications that come with COVID-19. Consequently, those who live on low and fixed incomes face greater barriers to accessing adequate nutrition. This can, in turn, further increase their vulnerability to poor health outcomes.

“A lot of older adults, unfortunately, don’t have a generous retirement income,” explains David Buys, PhD, MSPH, an associate professor at Mississippi State University Extension and College of Agriculture and Life Sciences who has studied food insecurity in older adults. “They might be living on nothing but Social Security. Some might not have Social Security. We know that we have an increasing number of grandparents raising grandchildren … that can be a challenge.”

Buys says that older adults who are frail or lack transportation may struggle to get to the grocery store or to a food pantry — and that some are afraid to go out and risk exposing themselves to infection.

Food banks, food pantries, and other community outreach organizations have had to be creative in ways that they serve older adults since the pandemic hit, such as delivering food to their homes, drawing on long-standing programs like Meals on Wheels, Buys says.

One study from before the pandemic found that, in a group of older adults discharged from the hospital, those seniors that received meals delivered by Meals on Wheels had lower rates of hospital readmission in three and six months than expected.

Providing healthy meals can be a key to keeping older adults healthy and out of the hospital or congregate health care situations that might increase their risk of contracting COVID-19. It’s an issue of particular concern since more than 84% of people over the age of 65 have at least one chronic condition and many face economic hardship as a result of medical debt, according to the National Council on Aging.

Immigrants in the United States illegally: While Latino communities in the United States in general have been disproportionately impacted by the pandemic, immigrants in the country without legal permission — many of whom are Latino — are particularly vulnerable to food insecurity because they are not eligible for many government relief programs. Even before the pandemic, 1 in 4 experienced food insecurity, according to a 2016 report by Bread for the World, a nonprofit dedicated to ending hunger.

While Medicaid programs in some states, including California and Massachusetts, are beginning to cover the cost of programs that provide food to patients, people living in the country illegally are not eligible for Medicaid. Nor are they eligible for the Supplemental Nutrition Assistance Program, formerly known as food stamps, nor the $1,200 stimulus check that the federal government approved earlier this year.

“We see a movement right now to integrate more food and nutrition services into health care delivery and financing,” explains Sarah Downer, JD, associate director of whole person care at the Center for Health Law and Policy Innovation of Harvard Law School. “But every gap that we have is a place where undocumented immigrants fall into that gap.”

Instead, many rely on local food pantries for aid, which were stretched thin early in the pandemic while trying to accommodate millions of new clients, says David Velasquez, a fourth-year medical student at Harvard Medical School who is also pursuing a master of business administration at Harvard Business School and a master in public policy at Harvard Kennedy School.

Velasquez, who experienced food insecurity himself as the child of Nicaraguan parents who originally came to the United States illegally before being granted asylum, decided during the early months of the pandemic to research policies that could support food access for immigrants during this crisis.

He teamed up with another Harvard medical student, Jordan Kondo, and two attorneys from the Center for Health Law and Policy Innovation, Downer and Emily Broad Lieb, JD, to write a journal article that argued for policies that could help bring relief to immigrants who aren’t eligible for much government aid.

For example, they said the government should make it a priority to fund emergency food services programs that are accessible to those living in the country illegally, such as food banks and community health centers, and that health systems should ensure that they are not excluded from programs that integrate nutrition into health care delivery.

“Food is a basic human need,” Velasquez says. “And it’s something that we all deserve.”

Facing a long-term problem

When Mirsky was crafting the model for MGH Revere’s therapeutic food pantry, it was important to him that the pantry provide not only nutritious food but also the means to enjoy it.

Patients who visited the pantry initially received pots and pans, a spatula, oil, spices, and consultations with a nutritionist who could help them come up with recipes that they enjoy. The goal is to foster self-motivated healthy lifestyles. When the pantry expanded to a greater number of patients due to the pandemic, they could no longer offer all these services, but they hope to reintroduce them in the future.

“Food and eating are an essential part of the human experience,” Mirsky says. “Cooking and enjoying healthy food is a very powerful and respectful way of improving someone’s life.”

The MGH Revere pantry in the Boston area is just one of many nutrition outreach programs that health care providers across the country have increasingly implemented in recent years, as the American Hospital Association highlights in its social determinants of health report series. More health care providers are screening for food insecurity regularly and helping connect their patients to resources.

Still, food insecurity persisted before the pandemic, and the pandemic has further stretched existing community resources, as NPR reported in September.

Mirsky notes that the pantry at MGH Revere is already feeling the strain and is leading an effort to raise funds for a permanent location for the pantry. He’s also concerned about how much food they will be able to acquire in the winter, when there will be less local produce available and as renewed COVID-19 surges threaten to further stress systems.

“Our goal is to recognize that this is a very long-term problem that is going to require a long-term solution.”

Housing and Food Law During Covid-19

On September 23, Harvard Law School’s Colloquium series titled, COVID-19 and the Law: Law and Policy to Address Basic Needs and Marginalized Populations, hosted a discussion on Housing and Food Law, featuring Emily Broad Leib, Clinical Professor of Law and Faculty Director of the Food Law and Policy Clinic; Julie McCormack, Senior Clinical Instructor and Director of the Safety Net Project at Legal Services Center; Eloise Lawrence, Assistant Clinical Professor of Law and Deputy Faculty Director of the Harvard Legal Aid Bureau; and Joseph Singer, Bussey Professor of Law with the discussion moderated by David Harris, Managing Director of the Charles Hamilton Houston Institute for Race and Justice.

Visit the Colloquium’s website for more information, and watch the recording here:

CHLPI and Quinnipiac Legal Clinic Urge Federal Appeals Court to Hold Firm on ACA Civil Rights Protections for Transgender and Reproductive Health Care

Today, the Center for Health Law and Policy Innovation of Harvard Law School and the Quinnipiac University School of Law’s Legal Clinic filed an amicus brief on the need for state liability to uphold the Affordable Care Act’s civil rights protections. The brief was filed on behalf of a coalition of thirteen nonprofit civil rights, advocacy and public interest organizations who work to broaden access to health care.  Filed in the United States Court of Appeals for the Fourth Circuit, the brief supports the plaintiffs in Kadel v. Folwell, a case that challenges North Carolina’s exclusion of transition-related care in its state employee health plan.  A U.S. District Court rejected North Carolina’s attempt to dismiss the lawsuit, and the state has since appealed the decision. The plaintiffs-appellees are being represented by Transgender Legal Defense & Education Fund and Lambda Legal.  In its attempt to dismiss the ACA Section 1557 discrimination claim, North Carolina has argued that a legal doctrine called sovereign immunity means the state should be protected from damages in these types of lawsuits.  Our brief describes how allowing states to escape Section 1557 liability will harm transgender and gender non-conforming people and people seeking reproductive health services.  We also discuss the important role compensatory damages play in making civil rights protections meaningful.

Read the amicus brief here. 

How COVID-19 Threatens The Safety Net For US Children

Originally written by Jessica Bylander and published on Health Affairs on October 6, 2020.


ABSTRACT

School closures appear to slow the spread of the virus, but for many children the health ramifications are far broader.

TOPICS


 When the coronavirus disease 2019 (COVID-19) pandemic forced most schools to transition from in-person to remote learning in the late spring of 2020, life changed for parents and kids overnight. As parents faced grim and costly choices about whether they could continue to work with their kids at home, children faced unprecedented losses on both academic and social fronts. But many US children lost even more when schools closed: access to healthy meals, health and mental health care, special-needs services, technology, and a safe haven.

For Naomi Shapiro of Chicago, Illinois, school closure meant a temporary loss of essential therapies for her child with special needs. Shapiro’s youngest son has an 18q deletion, a missing piece on chromosome 18, which caused some developmental delays and hearing loss. Pre-pandemic, her son attended a pre-kindergarten program through Chicago Public Schools for children who are deaf and hard of hearing.

“He gets speech therapy, occupational therapy, physical therapy all at school,” Shapiro says. So when the school closures hit the city, “all of his therapies were on hold,” she says.

The data on the risks of COVID-19 for children is evolving. Initial reports suggested that children were not getting infected at high rates or contributing greatly to the spread of the disease. Although most infections in children are mild or asymptomatic, the Centers for Disease Control and Prevention (CDC) has since found that one in three children hospitalized for COVID-19 were admitted to an intensive care unit.1 A Chicago study published in JAMA Pediatrics also found that children infected with COVID-19 had similar levels of the virus on their nasal swabs as adults, suggesting that kids can spread disease.2

Although early COVID-19 modeling studies predicted that school closures alone would prevent only 2–4 percent of deaths,3 a later analysis found that school closure was associated with a significant decline in both COVID-19 incidence and mortality.4 In short, closing schools made sense.

Yet beyond the health risks posed to children by the virus itself, there are well-known health risks of school closures and the loss of the essential health and social services that schools provide. The pandemic has highlighted the urgent need for policy reforms that strengthen the safety net and welfare system for children, relieving some of the pressure on schools.

“Schools are a huge safety net, and we have to protect them as a safety net,” says Rhea Boyd, a pediatrician and public health advocate. “But the pandemic is also telling us how vulnerable that safety net is.”

Initiatives at the federal, state, and local levels are attempting to fill the gap, with varying levels of success. But the piecemeal approach and lack of clear guidance, which has left many families to chart their own course, is likely to deepen existing inequities faced by disenfranchised groups, such as children of color and low-income kids.

“Nobody wants more COVID cases, obviously, but we do have to think a little broader about the health trade-offs,” says Taryn Morrissey, an associate professor at American University, in Washington, D.C.

“Children are going to pay for this for decades to come. They will with lower earnings, they will with less education, and they will with poorer health. And certain groups of children are going to pay more.”

FOOD INSECURITY AND SCHOOLS

Much attention has been focused on kids’ access to healthy food when schools are closed, given the outsized role schools play in providing food security. In fiscal year 2019, 29.6 million children were served by the National School Lunch Program, and 14.8 million children were served by the School Breakfast Program; both programs provide free and reduced-price meals to children who qualify.5 The health harms of food insecurity are many, including fatigue; reduced immune response; and long-term developmental, psychological, physical, and emotional harms.6

Beginning in the spring, school districts and states began implementing three main alternative methods of providing school meals during the closures: on-site food pickup sites, meal deliveries, and Pandemic-EBT (P-EBT) cards, which provide the cash value of the school meals to families who would have received them if schools were open. The US Department of Agriculture (USDA) has issued waivers to allow schools to bypass certain child nutrition program requirements (for instance, allowing meals to be served outside of standard meal times and in nongroup settings) but notably has not required schools to provide food service during closures.6

The USDA also partnered with the Baylor University Collaborative on Hunger and Poverty and others to deliver meals to low-income kids in rural areas across the country through a program called Meals to You; permitted more families to receive the maximum Supplemental Nutrition Assistance Program (SNAP) benefit ($768 per month for a family of five, for instance); and expanded access to a pilot program that allows SNAP beneficiaries to buy food online. As of August 2020, the USDA said that nearly 40 million meals had been distributed through Meals to You, more than 99 percent of eligible children were covered by Pandemic-EBT, and more than 78,000 locations were offering meals for children while schools are closed.7 The proposed Heroes Act would extend Pandemic-EBT through fiscal year 2021 and expand the program to young children who had been receiving meals and snacks from child care providers.

Yet some families who relied on schools for healthy meals will certainly fall through the cracks; when schools serve free meals at sites over the summer, for instance, they reach only one in seven children who usually receive meals during the school year.6 The Pandemic-EBT benefit of $5.70 per day in most states also doesn’t stretch very far at retail stores.8

“The amount of money that goes onto the P-EBT card is the equivalent of the cost of meals at school,” says Emily Broad Leib, clinical professor of law at Harvard Law School and faculty director of the Harvard Law School Food Law and Policy Clinic, in Boston, Massachusetts. “That amount doesn’t really equate to meals bought on the private market.”

In May 2020 recommendations, the Food Law and Policy Clinic urged Congress to “meaningfully increase” the Pandemic-EBT benefit amount, as well as meaningfully increase SNAP benefits in general.9

“One of the reasons families rely so much on schools is our other food benefits pay so little,” Leib says.

Cumbersome rules about who is eligible for free and reduced-price meals, and what geographic areas can deliver meals to all children in their area, have led to increased calls for a universal free meal program for all children in US schools.

“We’re so concerned that someone who doesn’t make a low enough amount of money will use a program that we make access to the program really, really administratively complicated,” Leib says. “It would be good for everyone if there were the expectation that healthy meals would be served to everyone.”

On July 30, Rep. Bobby Scott (D-VA), chair of the House Committee on Education and Labor, introduced the Pandemic Child Hunger Prevention Act, which would temporarily make all students eligible for free school meals during the 2020–21 school year, either in school, at grab-and-go sites, or through meal delivery.10

In Boston Public Schools, which Leib’s children attend, all students are eligible for free breakfasts and lunches regardless of their income status—part of the USDA’s Community Eligibility Provision for schools and school districts in low-income areas.11,12 So when the schools closed, Leib says there were grab-and-go sites “everywhere,” and every student’s family was sent a Pandemic-EBT card.

“It made it easier to make sure kids didn’t get lost along the way.”

Meanwhile, for the 4.5 million young children served meals at child care settings and after-school programs through the Child and Adult Care Food Program, there were significant gaps in food access while child care programs were closed because of the pandemic.13

“Schools continued to get funded during the closure, so they could do grab-and-go or whatever they were trying to do,” says Gina Adams, a senior fellow in the Center on Labor, Human Services, and Population and director of the Low-Income Working Families project and the Kids in Context initiative, all at the Urban Institute, in Washington, D.C. “Child care programs couldn’t. They were closed; they had no money.”

In a July 2020 brief the Urban Institute urged policy makers, communities, and other stakeholders to develop a coordinated approach to meeting young children’s nutritional needs during the pandemic; and to support child care and early education programs’ capacity to feed children, such as by providing grants to child care centers to purchase and provide food during closures.13 Alternatively, policies that provide money directly to parents, such as Pandemic-EBT, may be a better option in the face of child care closures, Adams says.

CHILDREN WITH SPECIAL NEEDS

When Louisiana public schools closed in March, Kathryne Hart’s four-and-a-half-year-old son lost access to a profound number of services. Hart’s son has a variation in the UBA5 gene that causes seizures, vision loss, and extreme developmental delays. In the spring he was in a public preschool program where he was provided with a nurse, physical therapy, occupational therapy, speech therapy, adaptive physical education, and a teacher for the visually impaired, in addition to the special education teacher for the class. The family had just ironed out the details of the new services he would be receiving through his Individualized Education Program (IEP), a document created annually for each child in public school who is eligible for special education, which spells out agreed-upon supports and services to be provided in school.14 Then, schools and therapy clinics closed due to COVID-19.

“At the time, we couldn’t do anything,” says Hart, of Baton Rouge.

Without therapy, Hart’s son physically regressed, and he ended up hospitalized twice for problems that would have been detected earlier or prevented. By June the clinics reopened and prioritized kids with the most severe needs, and the family started receiving therapies virtually. But Hart’s son is still not receiving the level of care he received at school.

“We want to go back,” she says. “For him the risk of hospitalization is getting to the point that sending him to school isn’t any less dangerous.”

The pandemic has shifted onto many families the burden for providing services that had been coordinated by school systems under an IEP, leaving parents with only hard choices. They might, like Hart and her husband, assist with their child’s virtual therapy, pay out of pocket for home health aides or other helpers, use Medicaid funding for personal care assistants if possible, or simply stop the child’s therapy.

“There are families who are doing nothing at all, and they’re having a lot of behavioral issues,” says Georgia Mueller, program coordinator of the Missouri Family to Family Program, a statewide network of families offering free supports to people with disabilities and their families. “Families have had decent access for so long to decent therapy [through schools,] they just don’t know what to do.”

Mueller, whose twenty-one-year-old son has level 2 autism and receives personal care assistance through a Medicaid community support waiver, says the pandemic provides an opportunity to spread out the responsibility for providing special needs services.

“There is so much about this COVID experience that is making us rethink our policies,” Mueller says. “I see the prime opportunity to spread the responsibility to a variety of entities instead of it being [concentrated] in schools.”

For one, health insurance plans could play a bigger role in ensuring that children with special needs receive the services they need, she says. Within Medicaid, the Early and Periodic Screening, Diagnostic, and Treatment benefit provides “comprehensive and preventive health care services” to children under age twenty-one, including developmental and specialty services if needed.15 The benefit has “no peer” among private and other health insurance plans.16 Mueller would like to see such coverage become standard for all children’s health plans through age twenty-six. She also advocates for policies that can support families with children with special needs financially, which in turn could free up time and resources to provide or pay for their care at home. For instance, Mueller’s family participates in the Health Insurance Premium Payment (HIPP) program in Missouri, which helps families with a Medicaid-eligible member pay employer-sponsored insurance premiums.

“HIPP could be the difference between a parent who can stay home and implement those therapies and one who cannot,” Mueller says. “In our family, it’s $700 cash flow that I wouldn’t have otherwise.”

CONSIDERING EQUITY

Even before the pandemic, public schools struggled to fulfill their role as a public health and social safety net for children, particularly in the face of decreasing funding for many schools. This was particularly true of schools serving Black communities, says Sally Nuamah, an assistant professor at Northwestern University, in Evanston, Illinois, who has studied the impact of permanent school closures on children of color.

“When you take that and add a pandemic to it, we can predict who is going to end up bearing the brunt and the burden of this,” Nuamah says. “And that’s what we’ve seen.”

In addition to being more at risk for COVID-19 hospitalization,1 families and children of color and low-income families face disproportionate negative consequences when schools and child care centers close. According to a policy brief from the NAACP, women of color make up 40 percent of educators in child care centers and homes and half of home-based paid child care providers—a sector hard hit by pandemic closures.17 In addition, Black students account for 44 percent of students in high-poverty schools where more than two-thirds of students are eligible for free or reduced-price lunches, and many homes in low-income communities lack access to technology or high-speed internet to facilitate virtual learning.17

“I worry about kids that were already on the margins or vulnerable in some way,” says Nia Heard-Garris, a pediatrician and researcher at Northwestern University’s Feinberg School of Medicine. “I worry about all kids, but there are definitely some kids who I feel like are going to be hit a little harder.”

Time will tell what the health effects of the pandemic will be even for children who were not infected with the virus, Heard-Garris says, but prior research on major events such as 9/11 indicate that such major stressors can impact birth outcomes for pregnant women, children’s mental health, and obesity rates.

In addition, when schools are able to safely reopen, families and educators will need to contend with the loss of learning milestones while schools were closed or operating part time.

“It’s like leaving generations of kids behind,” pediatrician Boyd says. “After we get past ‘should schools reopen and how?’, the next stage is going to be massive remediation. What do we do for all the kids who were virtual drop-outs, who haven’t checked in when school went online, and who aren’t thriving in this virtual learning environment?”

Some families—especially those with flexibility, financial resources, or both—have begun to form learning “pods,” where families band together to facilitate online learning among a small group of children, perhaps by hiring a tutor, alternating taking time off work, or forming home-schooling pods with a paid teacher. Some advocates are concerned, however, that this approach will only deepen inequities.18

“They are absolutely going to reinforce the same racial and class divides that already exist in neighborhoods and then in classrooms,” Boyd says.

Whether outside organizations could intervene to make access to learning pods more equitable, and at a large enough scale, remains to be seen. Among some smaller efforts, researchers from the University of California Irvine are pairing education students to tutor and facilitate small-group learning.19 In addition, Harvard University student Evelyn Wong recently received funding from the Clinton Foundation for a COVID-19 student project to create an online platform that pairs underserved K–12 students with undergraduates and postgraduates from colleges and universities for mentorship and educational resources.20

As is clear, schools provide much more than academics for children; in the absence of those supports, Nuamah cautions against focusing narrowly on whether kids achieve learning milestones under new pandemic realities. Instead, the major focus should be on making sure the social and public health needs of children are equitably met.

“Achievement only has meaning in an equitable society,” she says. “What does it mean to achieve or to care about merit in a context where people are suffering such deep inequities related to their social conditions?”

Approaching equity in child outcomes and opportunity goes beyond the debate of whether to reopen schools so that children can access the safety-net services that schools were providing. Boyd argues that what’s really needed is a redistribution of wealth so that the safety net has fewer—if any—people to catch.

“Your family doesn’t need an EBT card if you make a living wage,” she says. “We don’t need a moratorium on evictions if everyone can afford rent and their mortgage. The government helped facilitate this gap; how can the government facilitate remediating it?”

NOTES

New Initiative to Mainstream Produce Rx Programs Promotes Access to Healthy Food for Lower-Income & At-Risk Groups

Initial research outlines opportunities to increase access to healthy foods during hunger & Covid-19 crises.

Today the Center for Health Law and Policy Innovation of Harvard Law School (CHLPI) announced the launch of Mainstreaming Produce Prescription (Rx) Programs, a new initiative to increase access to nutritious food and improve health outcomes for people with diet-related diseases.

With support from The Rockefeller Foundation, CHLPI will develop a national strategy to scale up Produce Rx programs within the United States’ health care and food systems. Along with today’s announcement, CHLPI released initial research, entitled Produce Prescriptions: a U.S. Policy Scan, that outlines which national and state-level laws and policies may support or hinder the expansion of Produce Rx programs.

Produce Rx programs enable health care providers to distribute vouchers for free or discounted produce to patients living with, or at risk of, diet-related health conditions such as diabetes or hypertension. Mounting evidence indicates that Produce Rx programs can improve health outcomes for individuals who are lower-income and/or living with diet-related disease, by promoting access to healthy foods and reducing the financial burden of maintaining a healthy diet. The current pandemic starkly demonstrates the importance of nutritious diets: it is estimated that 76 percent of deaths from Covid-19 are among individuals with an underlying condition, many of which are diet-related. Despite growing evidence for the effectiveness of Produce Rx, access to these programs remains limited.

“It’s time for our health care system to recognize Produce Rx interventions as both effective and critical forms of care by making them more readily available to patients who need them,” said Robert Greenwald, Faculty Director of CHLPI. “The unprecedented pandemic and economic crisis underscore this aim. Now more than ever, we need to promote access to services that can help manage chronic conditions that are placing so many Americans at increased risk from Covid-19, and we need people to have access to healthy food.”

“Produce Rx programs have been around for more than a decade now, and the results have generated significant interest among providers, payers, government officials, and patients alike,” explained Emily Broad Leib, Faculty Director of Harvard’s Food Law and Policy Clinic and Deputy Director of CHLPI. “Yet most of these programs are still funded through small private, local, or state grants that are narrowly targeted or time-limited. Through our initiative, we’re looking at current law and policy and gathering input from a wide range of stakeholders, to identify the best way to embed Produce Rx programs into our existing health care and food systems infrastructure in a more systemic way.”

The Mainstreaming Produce Rx Programs initiative launches at a time of heightened national attention to chronic illnesses, including diet-related diseases, and food access. Diet-related diseases continue to put people at a higher risk of severe Covid-19 symptoms, and the economic impacts of the pandemic have exacerbated rates of food insecurity. According to recent data, around 1 in 4 adults are currently food insecure; this number goes up to 32 percent for adults with children. While not a direct solution to the pandemic, CHLPI’s team notes that Produce Rx Programs can help prevent and mitigate the harmful effects of such public health emergencies and reduce the burden on overstretched hospitals and health care providers.

“The Covid-19 pandemic has reaffirmed the need for flexibilities in our health care, food, and public health systems,” said Katie Garfield, Clinical Instructor for CHLPI. “With the Mainstreaming Produce Rx Programs initiative, we have an opportunity to build innovative policies that better connect these systems, making them stronger and more resilient now and long after the pandemic is over.”

“Covid-19 has shown that fundamentally, food is medicine, and equitable access to healthy and protective diets is a matter of life or death for many Americans,” said Roy Steiner, Senior Vice President for the Food Initiative at The Rockefeller Foundation. “Expanding Produce Rx programs and integrating them into our existing health and food policies are critical steps to build a more nourishing and resilient U.S. food system.”

The initial research released today, titled Produce Prescriptions: a U.S. Policy Scan, provides an overview of opportunities and challenges for scaling up Produce Rx in existing health care and food access programs like Medicaid, Medicare, the Supplemental Nutrition Assistance Program (SNAP), and the Gus Schumacher Nutrition Incentive Program (GusNIP). CHLPI plans to release a broader National Produce Prescription Policy Strategy Report in 2021 to provide a roadmap for action on the issue.