The Global Food Donation Atlas Tackles Food Waste Policy

This article was originally written by Eve Gleeson and published by FoodTank on July 25, 2021. 

Recent research from the Harvard Law School Food Law and Policy Clinic (FLPC) and The Global FoodBanking Network (GFN) illustrates the diversity of food donation and waste issues around the world and proposes policy options for addressing these challenges.

The project, known as The Food Donation Policy Atlas, provides insight into food waste issues across governance systems, cultures, and geographies. The FLPC and GFN most recently published findings on Chile, Colombia, Guatemala, Peru, Singapore, South Africa, and the United Kingdom (UK). The organizations hope this research will illuminate barriers to food donation in these countries and help the regions develop better food donation and waste policies.

According to the United Nations, around 1.3 million tons of food– roughly one third of all food that is produced– go to waste every year. At the same time millions of people around the world still lack access to sufficient and nutritious food. The Atlas research indicates that food donation, which could address waste and hunger issues, can be partly addressed through better government policies.

The Atlas aims to provide “a menu of policies, some of which cost money, like grants or tax incentives, and some of which simply require government guidance,” Emily Broad Leib, Director of FLPC, tells Food Tank.

This recent research finds that food donors, such as restaurants and supermarkets, may struggle to understand existing food donation policies. If these policies are confusing or nonexistent, businesses may be reluctant to donate.

The report also recommends that governments remove financial barriers associated with food donation. Many countries covered in the latest reports do not offer monetary incentives. But GFN and FPLC believe that removing VAT expenses or awarding tax credits for donations can encourage food donations.

The Atlas’ other recommendations include standardized expiration labels, better food safety procedures, donation requirements or penalties, and government grants.

While countries can benefit from similar recommendations, the Atlas also underscores some important policy differences. For example, the UK is the only country with a dual date-labelling system, providing both a best by date and a safe until date. This is essential, the Atlas proposes, for saving food even when it is no longer at peak quality. It is also the only country that provides grants and incentives for food donation.

Singapore’s government stands out for its thorough governance on food safety standards of donated food. Singapore’s supply chain and hygiene regulations reassure both donors and recipients that donated food is safe to eat. On the other hand, Singapore must prioritize minimizing food waste due to its dependence on imported food and limited space for landfills.

Regardless of country-specific policies, the Atlas recommends that all governments and community-based groups prioritize transparency, communication, and collaboration.

Policy reform in this area requires government action, explains Emily Broad Leib. Governments have, or should have, a vested interest in addressing food donation and waste issues, she states.

Local organizations also have an important role to play. “National policies can establish country-wide goals, best practices, [and] resources… while community-based organizations can offer on-the-ground expertise, implementation planning, [and] relationships with local food producers and consumers,” Broad Leib tells Food Tank.

The FLPC and GFN have published research on fourteen countries in total. You can access this research on the Atlas’ library.

Prescriptions for Fruits and Vegetables a Blossoming Program

This article was originally written by Kathleen Doheny and published by WebMD on July 23, 2021. 

Chef Michel Nischan has won the prestigious James Beard Award four times, written cookbooks, and launched a restaurant with the late actor Paul Newman. But the motto on his website reveals what he’s really about: “Changing the world through food.”

As co-founder and chairman of Wholesome Wave, a nonprofit founded in 2007 to solve not just food insecurity but nutrition insecurity, he wants people to have not just enough food, but the right foods. And that means foods that will preserve health and delay or prevent a diagnosis of diabetes, high blood pressure, obesity, and other chronic ailments. When grocery money is scarce, experts know, produce is often replaced by cheaper, highly processed, unhealthy choices.

The solution, say Nischan and others, is to make fruits and vegetables affordable and accessible to people with food insecurity through produce prescription programs. His organization funds the National Produce Prescription Collaborative and partners with organizations to offer the programs. Across the country, other coalitions and programs have formed at the state and local levels to do the same.

The premise is simple: A health care provider or a health insurance plan provides a ”prescription” for produce. Patients redeem it at a local farmer’s market, grocery store, or a community-based sponsoring organization.

The programs have grown steadily, especially in the past 5 years, according to a report published this year. Funding has increased but still isn’t enough, experts say. And there are still major gaps in being able to get to produce.

The need is great. According to the U.S. Department of Agriculture, food insecurity did decline somewhat, from 11.1% of households in 2018 to 10.5% in 2019. But that rises to 34.9% of households with incomes below the federal poverty line. Single-parent, Black, and Hispanic households are more vulnerable than others.

Produce Prescription Programs: 2010 to 2020

During a recent webinar, Nischan and others provided a snapshot of current produce prescription programs. They identified 108 programs that began between 2010 and 2020, with 94 of those active as of December 2020.

  • The fastest growth in programs has been in the last 5 years.
  • Most of the programs use a farmers market or a grocery store to provide the produce.
  • Programs are fairly evenly divided throughout the country, but with gaps in areas of need.
  • Programs partner with farmers markets, retail groceries, or onsite programs.
  • Participants are typically screened for eligibility based on food insecurity, diet-related chronic diseases, or diabetes. But the trend now is for programs not to require these diagnoses but to screen more broadly about whether the person is food-insecure or is at risk of getting a diet-related disease.
  • Partnerships are often formed when a single or a few doctors or other health care professionals advocate for the programs. The downside: The programs may collapse without widespread support from the hospital or clinic.
  • Most of the programs also offer nutrition education or culinary instruction.
  • Programs that are tied in with the participants’ electronic medical records have greater success in attracting participants and can also easily document benefits.

Produce as a Prescription

According to the CDC, just 1 in 10 U.S. adults get enough fruits and vegetables daily. (Recommendations vary by age and sex, but adult women need at least 1.5 cups of fruit and 2.5 cups of vegetables daily; adult men, at least 2 cups of fruit and 3.5 cups of vegetables daily.)

The idea of boosting produce intake by writing it as a prescription seems simple. Instead of waiting until a patient’s blood sugar, blood pressure, weight, or other health measure is so abnormal that medication is needed, a doctor would refer the patient to a nutritionist and give them access to a produce prescription program. The doctor might say: “You have a high blood sugar level. If you don’t improve it, you may develop diabetes. Here is a prescription for produce that may help you delay or avoid that.”

The programs have the potential to save millions in medical costs for dialysis, surgeries, and other expenses, Nischan says. He and others are pushing for the programs to become common and reimbursable though health plans.

Some health care providers are already taking part, but advocates want it more widespread. “Once the HMOs see the cost savings, they will figure out how to make them available,” Nischan says. “If we can institutionalize it through policy,” he jokes, “I can retire.”

Why the focus on produce? Because of the ”tons of scientific evidence” that eating produce can improve health, Nischan says.

Where’s the Proof?

To gain widespread support for the programs, even advocates say, research must show they not only increase produce intake, but that the increased intake translates to better health. A sampling of what’s been found so far:

  • Children from low-income families, ages 2 to 18, who took part in a produce prescription program at a federal quality health center for 4 to 6 months did eat more fruits and vegetables, with an increase on average of a third of a cup for each visit.
  • In its 2020 annual report, Wholesome Wave says data from its Ohio program found an average overall drop of 0.5 points in the blood sugar test known as A1c, an average drop in systolic blood pressure (upper number) of 22.3, and a drop in diastolic pressure of 14.2. The body mass index (BMI) dropped on average by nearly 5 points, which could be enough to have an overweight person reach a healthy weight.
  • In a 4-month program for adults, providing a $10 produce voucher that could be redeemed at a food “farmacy” led to nearly half of the 49 participants seeing reductions in systolic (upper number) blood pressure, a small reduction in body mass index, and an increase in their exercise.

Participant Feedback

Those who take part in the programs are often grateful for the difference the produce prescriptions make, says Kaely Summers, the health equity manager at Adelante Mujeres, an Oregon-based nonprofit that empowers low-income Latina women. The group surveyed people who took part in one of its produce prescription programs. Among the responses:

“I’m eating more fruits and vegetables. My pain is going away and so is my anxiety.”

“The doctor had told my husband that he was overweight and pre-diabetic. Now, he lost 15 pounds. When he went to his checkup, the doctor was surprised and congratulated him.”

“My husband doesn’t need as much medicine anymore.”

“With the fruits and vegetables, my son lost weight and so did I.”

Gearing Up: Long-Term Support

Experts say financial support needs to be increased and made more stable, and health insurers need to start looking at produce prescription programs as a covered preventive health benefit.

The 2018 Farm Bill gave the Gus Schumacher Nutrition Incentive Program (GusNIP) mandatory funding and added a newly authorized produce prescription program. The funding increases in steps to $56 million for fiscal year 2023 and thereafter.

“Because GusNIP is funded at $50 million-plus per year, it has achieved baseline,” Nischan says. “Once a piece of legislation achieves ‘baseline’ status, it is a permanent part of an overall bill.”

So it will continue to be funded, but the challenge is to have the funding keep up with need, he says.

With the required private sector matching, GusNIP generates about $100 million a year, Nischan says. In reality, he estimates, funding of $25 billion yearly would be needed to take care of all the families struggling to afford produce. He bases that estimate on the approximately 45 million people eligible for the Supplemental Nutrition Assistance Program (SNAP, formerly known as food stamps) who he says ideally should have about $550 worth of fruits and vegetables per year.

In late 2020, Harvard’s Center for Health Law and Policy Innovation launched an initiative, “Mainstreaming Produce Prescription (Rx) Programs,” to increase access to nutritious food and to improve the health of those with diseases related to diet.

The Rockefeller Foundation is supporting the effort. A national strategy is being developed. While interest in the programs is widespread, according to Harvard experts, most of the programs are still funded with small private, local, or state grants. They are often narrowly targeted or time-limited. Their goal — as well as that of many experts — is to embed the programs into health care and food systems infrastructure.

During the webinar, Katie Garfield, an instructor at the Center for Health Law and Policy Innovation, noted slow but steady progress in making the produce prescription programs common. In an email interview, Garfield said that “ideally over the next 5 years, we should see an expansion of access to these programs. To support new programs and expand the reach of existing programs, it will be critical to create pathways to sustainable funding.”

More health care providers and health insurers have expressed interest in partnering with the produce prescription programs. For instance, some Medicaid managed care plans have set up pilot programs with the produce prescription programs. Garfield supports larger policy changes, such as including produce prescriptions as a covered benefit for Medicaid and Medicare participants.

Kaiser Permanente, a large health plan, is testing a produce prescription program with members who are food insecure and have diabetes, according to Pamela Schwartz, executive director of community health there.

Garfield says there is a long way to go. If you think of our health care system as a house, she says, the produce prescription programs are ”just sneaking in around the windows.”

She says they should be coming into the front door.

PrEP, the HIV prevention pill, must now be totally free under almost all insurance plans

This article was originally written by Benjamin Ryan and published by NBC News on July 21, 2021.

In a move that is expected to prove transformative to the national HIV-prevention effort, the federal government has announced that almost all health insurers must cover the HIV prevention pill, known as PrEP, or pre-exposure prophylaxis, with no cost sharing — including for the drug itself and, crucially, for clinic visits and lab tests.

This means the entire experience of maintaining a prescription to Truvada or Descovy, the two approved forms of PrEP, should now be totally free for almost all insured individuals. A prescribing physician, however, must persuade an insurer that Descovy in particular is medically necessary for any specific patient to qualify for zero cost sharing for that drug’s use as HIV prevention. 

The guidance that the Centers for Medicare and Medicaid Services, along with the Department of Labor and the Department of the Treasury, sent to health insurers Monday indicated that insurers have 60 days to comply with the mandate. The rule says insurers must not charge copays, coinsurance or deductible payments for the quarterly clinic visits and lab tests required to maintain a PrEP prescription. 

Insurers were already required to stop charging out-of-pocket fees for the medication by Jan. 1, 2021, at the latest. 

These additional requirements, which will lift what has likely been a substantial barrier to PrEP access for individuals with low income in particular, are the result of the U.S. Preventive Services Task Force granting this form of HIV prevention an “A” rating in 2019. Under the Affordable Care Act, such a rating for preventive health care services, including tests for various diseases such as HIV itself, means they must be covered by almost all insurers at no cost to the insured patient.  

HIV prevention advocates hailed the new guidance as a game changer in the effort to promote PrEP among individuals at risk of HIV.

“While we need state Medicaid authorities and departments of insurance to follow through on implementation, this memo from the federal government literally made me jump for joy,” Jim Pickett, senior director of prevention advocacy and gay men’s health at AIDS Foundation Chicago, said. “This has the potential to wipe out many of the access obstacles we face with PrEP provision. I look forward to radical improvements in PrEP access, particularly for the communities who are most vulnerable to HIV.” 

However, Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, pointed out that many insurers are still not complying with the rule indicating they cannot charge consumers for their Truvada or Descovy prescriptions. 

Robert Greenwald, a clinical professor of law at Harvard Law School, pledged to “work to enforce the new guidelines and ensure that the promise of this free preventive service to reduce the acquisition of HIV will be realized.”

Truvada, which contains a pair of antiretroviral medications also used to treat HIV, was approved for use as HIV prevention in 2012. Research indicates that when taken daily, the tablet reduces men’s risk of contracting the virus from sex with other men by more than 99 percent. PrEP reduces women’s risk of HIV by at least 90 percent

After a slow start, PrEP began gaining substantial popularity in 2014 as media attention about PrEP’s potential to turn the tide against the U.S. epidemic swelled. Descovy, which is associated with improvements in bone density and kidney function tests compared with Truvada, was given the green light by the Food and Drug Administration in 2019.  

Both drugs are manufactured by Gilead Sciences, which is the dominant player in the HIV treatment market. Since this spring, Truvada has been available in a generic form with a list price as low as $30 per month. By comparison, Descovy’s list price is currently $1,930 and Truvada’s is $1,842.

In May, the Centers for Disease Control and Prevention released an estimate that as of 2019, some 285,000 people were taking PrEP. This promising news was tempered by the fact that PrEP use remains largely limited to white gay and bisexual men. 

It is possible that total elimination of out-of-pocket costs for a PrEP prescription on the part of insured individuals may improve use of PrEP among Black and Latino men who have sex with men in particular. Together, these demographics comprised 46 percent of new HIV diagnoses in 2019, according to the CDC. Overall, about 70 percent of new HIV transmissions occur among gay and bisexual men.

The CDC also released a new estimate in May that during the mid-2010s, the annual rate of new HIV transmissions in the United States remained constant for a few years before declining by about 8 percent between 2015 and 2019, to some 34,800 new cases. 

A recent paper published in the Annals of Epidemiology by Aaron J. Siegler, an associate professor at the Rollins School of Public Health at Emory University, and his colleagues found that states that expanded their Medicaid programs under the Affordable Care Act and those that offered programs to offset the costs of PrEP benefited from greater use of the prevention modality. In other words, if people can access PrEP at a lower cost or for free, they are more likely to take it. 

“Now it is important that people who are eligible for PrEP, along with their providers, are aware of these new requirements,” Schmid said of the new guidance to insurers regarding PrEP-related cost sharing. “We also have to hold insurers accountable to ensure they are doing their job in complying with their legal obligations. Plan reviews still show many insurers are not in compliance, and we need state insurance regulators to enforce the law and the new guidance.”

While the future is looking bright for access to PrEP on the part of people with health insurance, a fiscal crisis awaits clinics providing this form of HIV prevention to the uninsured population, as NBC News previously reported. Gilead readily provides PrEP for free to lower-income people who lack health insurance, but the pharmaceutical company does not cover the associated clinic visits and lab tests. And thanks to a crucial fiscal policy change the company has pledged to make starting Jan. 1, 2022, at least $100 million in funds that clinics that care for underserved populations have been using to cover those ancillary costs is expected to drain from their budgets. 

Leaders at these clinics expect access to PrEP for people lacking health insurance to narrow as a result, possibly counterbalancing the improved access their insured counterparts will now enjoy thanks to the new federal guidance.

Kenyon Farrow, managing director of advocacy and organizing at the activist group PrEP4All, called upon the federal government “to look for ways to cover people who are uninsured, particularly in non-Medicaid-expansion states, to be able to access PrEP services.” 

“If we’re serious about ending the HIV epidemic,” Farrow said, “we have to ensure equal access to PrEP in all communities and not only for the insured.”

Breaking Down Barriers to Hep C Treatment

This article was originally written by Jennifer Tzeses and published in HealthCentral on July 20, 2021. 

A SNEAKY, SILENT killer, hepatitis C is a viral infection that often shows no signs or symptoms. And because most people don’t know they have it, the virus can linger in your system for decades—until complications crop up, potentially causing cirrhosis (scarring) or liver cancer. According to the Centers for Disease Control and Prevention, it’s the deadliest infectious disease in the U.S.—and it’s widespread. The Food and Drug Administration reports it’s the most common chronic blood-borne infection in the United States with roughly 3 to 4 million new infections occurring each year.

For reasons not quite understood, about 30% of people who have hep C clear the infection through their own immune system, according to the World Health Organization. For the remaining 70%, treatment can mean the difference between life and death. The (really) good news in all of this is hep C is 98% curable, thanks to a class of medications known as direct-acting antivirals (DAAs) and often in as little as eight to 12 weeks. (That’s true even if you contracted hepatitis C 30 years ago and are just seeking treatment now.) Keep in mind, though, that there is no vaccine for hep C. So if you get treated, then keep doing whatever caused you to contract the disease the first time, you can still get it again.

While DDAs are basically a magic wand for hep C sufferers, those on Medicaid have historically faced a host of unfair barriers to treatment access. “When the drugs came out in 2014, there was a giant price tag, and so payers like Medicaid created rationing schemes for fear they would blow a hole in their budgets if they treated everyone,” says Phil Waters, J.D., staff attorney, Center for Health Law and Policy Innovation at Harvard Law School in Boston. In turn, Medicaid began to limit access to coverage by implementing three main restrictions: liver disease progression, sobriety requirements, and prescriber restrictions, Waters says.

Liver Disease Progression

Thanks to this restriction, patients are required to reach a certain stage of fibrosis before being eligible for treatment in the Medicaid program. “Fibrosis is the amount of damage done to your liver measured on a scale of zero to four with zero meaning no scarring and four essentially being liver failure,” Waters says. “Medicaid programs made a cutoff for fibrosis levels to limit treatment. In Arkansas for example, you don’t get access to treatment unless you’re at three or above, which is almost a cirrhotic level,” he says. “It’s basically telling people with a deadly infectious disease that they have to wait until they get sicker to be treated.”

Substance Use and Sobriety Requirements

Patients with a history of substance or alcohol abuse need to show they are free of drugs or alcohol before they are approved for treatment under Medicaid. “Not treating people who are active users is not only wrong from a moral standpoint, but from a public health perspective, since these are the individuals who are most likely to spread Hep C to others,” Waters says. “It’s hard to see this as anything other than a cost containment measure or, really, reinforcing stigma against drug users for being honest.”

Prescriber Restrictions

Only certain specialists are allowed to prescribe DDAs. Which, in theory, sounds feasible, however, “in a state like West Virginia where there’s one hepatologist in the entire state, it starts to make sense why there’s a bottleneck for an entire cohort of patients that need this treatment,” Waters says. And along with limited prescribers, prior authorization protocols required by certain plans end up delaying treatment even further. “The provider has to fill out extensive paperwork certifying they are in fact a gastroenterologist or hepatologist and show that a patient has been clean and sober. This is in addition to lab reports,” Waters says.

Consequences of Barriers to Care

“These restrictions delay and restrict access to care for tens of thousands of Americans, not only allowing their health to deteriorate, but also undermining public health efforts to eliminate viral hepatitis by 2030,” says Adrienne Simmons, PharmD, director of programs for the National Viral Hepatitis Roundtable (NVHR), an advocacy organization in Washington, D.C. “Every new HCV infection represents a failure to cure the index case, and a generation struggling to survive the overdose crisis will face long-term health consequences—cirrhosis, cancer, transplant, and death from HCV if Medicaid policies are not revised to facilitate access to treatment now.”

Thankfully, there are groups advocating for change—namely, Hepatitis C: State of Medicaid Access, a joint taskforce between CHLPI and NVHR. Through a national report and state-by-state report cards, the group provides an evaluation of treatment access in each state’s Medicaid program. “The report cards track prior authorization requirements for HCV treatment-based liver damage, sobriety, and prescriber restrictions,” Simmons says. “This data guides our administrative and legislative advocacy efforts and arms local advocates with the information they need to push for the removal of restrictions in their state.”

The changes can’t come soon enough for patients and hep C advocates, who are still battling for access to care. “Providers are reticent to treat people who are actively using drugs because they heard from their infectious disease colleagues in the interferon [drug] days about how difficult treatment was to manage,” Waters says. “And so, they just get scared and say, ‘Nope, not going to do it. This is too difficult.’ I think that kind of thinking permeates the medical community and the people who make payment decisions.” The biggest reason states who have removed restrictions for fibrosis are keeping sobriety restrictions in place, he says, is because of fears about reinfection or treatment adherence. “It’s a political capital problem,” Waters says.

Progress Makes Perfect

Sobriety restrictions remain the most pressing and widespread barrier to accessing hepatitis C treatment. “Many states have reduced restrictions regarding required periods of abstinence yet screening and counseling restrictions continue to amplify stigma surrounding alcohol and drug use and create additional hurdles for patients seeking treatment,” says Simmons. Questions about substance use and adherence on prior authorization forms only end up creating the opportunity for providers to discriminate against patients based on non-evidence-based assumptions about adherence, she adds. This often discourages people who use drugs from seeking testing and treatment.

Still, progress is happening. Since 2017, 32 states have either eliminated or reduced their fibrosis restrictions, 21 have loosened their sobriety restrictions, and 25 have scaled back their prescriber restrictions for Medicaid coverage, Simmons says. There are now also seven states that, in addition to removing all restrictions, have removed prior authorization for treatment entirely: these include Washington, Louisiana, New York, California, Indiana, Wisconsin, and most recently, Michigan. Says Simmons, “In these states, the barriers to getting treatment through Medicaid have been paved over with a road to treatment.”

Support for the Zero Food Waste Act

Each year, between 30-40% of all food in the United States is unsold or uneaten. Most becomes food waste, heading straight to landfill, incineration, down the drain, or left in the fields—all while millions face hunger and our ecosystems are degraded. Addressing this challenge is essential to building a regenerative and resilient food system that helps to mitigate climate change, reverse nature loss, and feeds more people.

Today, the Zero Food Waste Act was introduced in the House by Representatives Julia Brownley (D-CA), Ann McLane Kuster (D-NH), and Chellie Pingree (D- ME), while Senator Cory Booker (D-NJ) introduced companion legislation in the Senate. This legislation would advance the goal of halving US food loss and waste by 2030 and reduce the climate impacts of food waste by establishing a new EPA program for state, local, and tribal communities to lead efforts to measure, prevent, and build the infrastructure necessary to decrease food waste across America.

Under the bill, planning grants could be used by states and local, tribal, and territorial governments to investigate the kinds of food waste mitigation projects or policies that would be most impactful in their communities. Measurement grants could be used by states and local, tribal, and territorial governments to better understand the amount of food waste generated in the state or community.

Reduction grants could be used by states and local, tribal, and territorial governments, as well as nonprofits, to fund a variety of different types of projects. For example, food waste prevention projects could stop the generation of food waste. Recycling projects could reuse food waste as a feedstock for other non-food products, such as composting. Rescuing projects could redirect surplus food to places like food shelters. Upcycling projects could make new food from ingredients that would otherwise go to landfills. Additionally, localities could use the grant funding to implement food waste landfill disposal or incineration restrictions designed to stop food waste.

Reducing food waste is an important component in the fight against climate change, while also being a more efficient use of our natural resources and a way to create new jobs in the resulting industry. FLPC, WWF, NRDC, ReFED and supporters of the national Food Waste Action Plan welcome the introduction of the bill and strongly support its passage.

ACLU & Harvard Law Clinic’s Settlement on Prisoners’ Health Care Rights With Vermont’s Department of Corrections Is Preliminarily Approved

Settlement will expand access to the Hepatitis C cure for incarcerated Vermonters.

A federal district court in Burlington gave preliminary approval on a class action settlement reflecting Vermont’s agreement to improve and expand access to the Hepatitis C cure for people in Department of Corrections (DOC) custody. The settlement will resolve the class action lawsuit filed in 2019 on behalf of hundreds of incarcerated Vermonters by the ACLU of Vermont, the Center for Health Law and Policy Innovation of Harvard Law School (CHLPI), and Costello, Valente & Gentry, P.C. (CVG), which challenged the DOC’s policy and practice of denying lifesaving medical care to hundreds of incarcerated Vermonters.

ACLU of Vermont General Counsel Jay Diaz: “This case is about Vermont recognizing the basic health care rights of all individuals incarcerated and in its custody. Hepatitis C is a silent epidemic impacting thousands of Vermonters and millions across the United States, but it is also curable. If Vermont is going to stop the spread of Hepatitis C, it is critical that we expand access to treatment to all who need it. While DOC has fallen short of providing the cure for all incarcerated Vermonters in the proposed settlement, this agreement represents an important step towards addressing past failures and recognizing the basic dignity and humanity of people in Vermont prisons.”

Hepatitis C (HCV) is an infectious viral disease that affects hundreds of incarcerated Vermonters and thousands more people across the state. The disease — identified by the CDC as among the deadliest infectious diseases in America — if left untreated, is likely to cause a variety of medical symptoms, including permanent liver damage, and in some cases, cancer and death.

The settlement agreement features several provisions to ensure that incarcerated Vermonters will have expanded access to the Hepatitis C cure, including:

  • DOC will follow a newly adopted, written treatment policy and provide treatment to sentenced people with Hepatitis C, unless they are soon to be released, or those who are “especially compromised” ,
  • The Court will maintain jurisdiction to make sure that DOC maintains the policy and properly follows its requirements;
  • People in DOC custody who believe they have been improperly denied access to the Hepatitis C cure can work with the class counsel for informal resolution before going directly to court and bypass the lengthy and complex administrative grievance process; and
  • DOC will provide class counsel with regular reports on the execution of the policy to make sure that it is being implemented. 

Center for Health Law and Policy Innovation of Harvard Law School Director of Litigation Kevin Costello: “In prior years, Vermont officials needlessly endangered people’s lives and allowed a curable disease to spread.  That went on for too long.  Now, with this settlement, and thanks to the courageous plaintiffs and other Vermonters willing to challenge an unjust policy, the people in our prison system who are impacted by this awful disease have access to treatment.  We will work hard to ensure that Vermont lives up to the promise of this new policy.”

Costello, Valente & Gentry, P.C. President James Valente: “This settlement brings to a close the first major undertaking of CVG’s Social Firm.  We were proud to work with the extraordinary lawyers at the Vermont ACLU and faculty and students from Harvard Law School.  Their skill, expertise and tenacity were necessary to achieve systemic improvements to Vermont’s correctional care which will save lives and alleviate suffering.”

The class action lawsuit was filed in May 2019 on behalf of Richard West, a now-former Vermont inmate, and Joseph Bruyette, a current Vermont inmate, and was certified as a class action in April 2020. The Plaintiffs argued in the complaint that DOC’s refusal to provide treatment is unconstitutional because it violated the Eighth Amendment’s prohibition on cruel and unusual punishment.

The settlement and other case materials are here.

Nebraska Improves Access to Hepatitis C Treatment for Medicaid Patients

Nebraskans covered by Medicaid no longer need to wait until they have advanced liver scarring to receive treatment for hepatitis C; however, stringent sobriety restrictions persist.

The Center for Health Law and Policy Innovation of Harvard Law School (CHLPI) and the National Viral Hepatitis Roundtable(NVHR) today applauded Nebraska Medicaid for removing their minimum fibrosis requirement for hepatitis C treatment, meaning Nebraskans covered by Medicaid no longer need to wait for more advanced liver scarring to receive access to treatment for hepatitis C virus (HCV). Fibrosis – or liver scarring – is assessed on a scale from F0, or no scarring, to F4, or cirrhosis. Before July 1, 2021, Nebraskans on Medicaid needed to wait until their fibrosis score was at least F2. Although lifting this restriction will increase access to effective HCV treatment for thousands of Nebraskans living with the virus, restrictions on patient sobriety remain in place. As one of 13 states who require a period of abstinence, Nebraska imposes the most stringent sobriety restriction by requiring Medicaid beneficiaries to abstain from drugs and alcohol for 6 months before being eligible to receive treatment.

“Nebraska has taken an important step towards hepatitis C elimination by removing its fibrosis restriction for Medicaid patients. However, sobriety requirements remain intact and are unnecessarily jeopardizing access to a cure for many Nebraskans,” said Adrienne Simmons, Director of Programs at NVHR. “As one of only four states in the country who required patients to wait until their liver disease had progressed before they were eligible to receive treatment, this decision to reverse an arcane policy will reduce suffering and improve health outcomes for Nebraskans impacted by a curable disease.”

Cases of HCV, a viral infection that causes liver inflammation and is one of the leading causes of liver disease, have been increasing since 2010 due to the ongoing opioid crisis. Today’s treatment for hepatitis C can cure most people in 8 to 12 weeks. Yet barriers to this treatment persist across the country.

“The notion that people who use drugs or alcohol may be nonadherent to HCV direct-acting antiviral therapy or risk reinfection is not backed by the data, and denying life-saving HCV treatment to persons with substance use disorder violates the Americans with Disabilities Act,” says Robert Greenwald, Clinical Professor of Law at Harvard Law School and the Faculty Director of CHLPI. “We know that unsafe drug use drives most HCV infections, and so we must remove sobriety restrictions in order to achieve public health goals of eliminating viral hepatitis.”

The removal of fibrosis restrictions for hepatitis C treatment has improved Nebraska’s score on the Hepatitis C: State of Medicaid Access from a C- to a B-. This designation is a step forward in the fight to improve patient access to HCV treatment and towards eliminating HCV as a public health threat. 

For more information about hepatitis C treatment access barriers, please visit

The lie of “expired” food and the disastrous truth of America’s food waste problem

This article was written by Alissa Wilkinson and published by Vox on July 8, 2021. 

Maybe you know the routine. Every so often, I go through my refrigerator, check labels on the items, and throw out anything that’s a month, or a week, or maybe a few days past the date on the label. I might stop to sniff, but for my whole adult life, I’ve figured that the problem was obvious — my jam or almond milk or package of shredded Italian cheese blend had “expired” — and the fix was simple: Into the garbage it goes.

This habit is so ingrained that when I think about eating food that’s gone past its date, I get a little queasy. I’ve only had food poisoning once or twice in my life, always from restaurants, but the idea is still there in my head: past the date, food will make me sick. You’ll probably never catch me dumpster-diving.

I know, on some intellectual level, that throwing away food is probably wrong. The statistics are damning. Forty percent of food produced in America heads to the landfill or is otherwise wasted. That adds up. Every year, the average American family throws out somewhere between $1,365 and $2,275, according to a landmark 2013 study co-authored by the Harvard Food Law and Policy Clinic and the Natural Resources Defense Council. It’s a huge economic loss for food growers and retailers, who often have to ditch weirdly shaped produce or overstocked food that didn’t sell.

Environmentally it’s bad, too. The study found that 25 percent of fresh water in the US goes toward producing food that goes uneaten, and 21 percent of input to our landfills is food, which represents a per-capita increase of 50 percent since 1974. Right now, landfills are piled high with wasted food, most of which was perfectly fine to eat — and some of which still is.

On top of this, I know that in the same country that throws away so much food, about 42 million people could be living with food insecurity and hunger. Yet state-level regulations often make it difficult to donate past-date food to food banks and other services.

America has a food waste problem. But I’ve rarely been clear on how that translates to how I actually treat the food in my refrigerator. Because what can you do, right? When the date says it’s done, it’s done, right?

Apparently, very wrong. Researchers have found that “expiration” dates — which rarely correspond to food actually expiring or spoiling — are mostly well-intentioned, but haphazard and confusing. Put another way, they’re not expiration dates at all. And the broader public’s misunderstanding about them is a major contributor in every single one of the factors I named above: wasted food, wasted revenue, wasted household income, and food insecurity.

If you’ve been throwing out food based on the freshness label, though, you’re not alone. It’s a widespread practice. Chef, journalist, and cookbook writer Tamar Adler, author of An Everlasting Meal: Cooking with Economy and Grace, explains: “In the absence of culinary information, people assume that any information they’ve been given must be the most important information.” A big part of the problem is that most of us don’t really believe we’re capable of determining if a food is good for us.

“It’s really hard to imagine you’re supposed to trust your own nose and mouth,” Adler said. “Add that to convenience culture and rapacious late-stage capitalism and, well, we’re fucked.”

The good news is that the problem wouldn’t be all that hard to fix, in the abstract. The bad part is that solving the broader system around it takes time, education, and a shift in our consumption habits. But the incentives for virtually everyone involved are high — and a good place to start is by figuring out what those labels actually mean and how to interact with them.

Everything you assume about date labels is probably wrong

There are two vital facts to know about date labels on foods in the US: They’re not standardized, and they have almost nothing to do with food safety.

Date labels first started appearing in the decades following World War II, as American consumers increasingly moved away from shopping at small grocery stores and farms and toward supermarkets, with their rows of packaged and curated options. At first, manufacturers printed a date code on cans and packages for the benefit of the grocer, so they’d have a guideline for when to rotate their stock. The label was not designed for consumers. But since shoppers wanted to buy the freshest food on the shelf, savvy folks started publishing booklets that gave a guide for deciphering the codes.

Eventually, producers — seeing that shoppers actually wanted to know what those secret dates were — started including more clearly readable dates on the packages, with month, day, and year. They saw it as a marketing boon; it was a way to attract consumers and signify that your food was fresh and flavorful. Consumers loved it, and the so-called “open date” labels became common. But there was little consistency about them.

And while the federal government made some attempts beginning in the 1970s to enact legislation that would standardize what those labels mean across the country, they failed. (The exception is infant formula, for which there are strict federal guidelines.) Instead, the burden fell on state (and sometimes local) legislatures, which passed laws that varied wildly, often relying on voluntary industry standards. One state might never require labels; another may mandate that the freshness label on milk have a date of 21 days after bottling; a third may set the same date at 14 days. (In my home state of New York, there are laws about labels, but the standards don’t mention dates at all — though certainly many manufacturers still put date labels on their products, and various municipalities at times set their own guidelines.) State-to-state discrepancies can be costly for manufacturers, who had to come up with ways to produce multiple labels for multiple regions. But it’s also baffling to consumers.

The labels are inconsistent, too. What the label actually indicates varies from producer to producer. So you might have a “best by” label on one product, a “sell by” label on another, and a “best if used before” label on a third. Those have different meanings, but the average consumer may not immediately realize that, or even notice there’s a difference.

Furthermore, those dates might not even be consistent across brands of the same food product — peanut butter, say, or strawberry jam. That’s partly because they’re not really meant to indicate when a food is safest. Most packaged foods are perfectly fine for weeks or months past the date. Canned and frozen goods last for years. That package of chips you forgot about that’s a month out of date isn’t going to kill you — they just might be a tiny bit less crunchy than you’d like. (The huge exception is foods like deli meats and deli salads, which won’t be reheated before they’re consumed and can pick up listeria in the production process — but that’s the exception, not the rule.) You can check for the freshness of eggs by trying to float them in a glass of water (if it sinks, it’s good). Properly pasteurized milk, which is free of pathogens, should be fine if it tastes and smells fine. But many of us, with the best of intentions, just look at what the label says and throw out what’s old.

Is this a scam?

When I first realized that date labeling wasn’t linked directly to scientifically backed safety standards but to a more subjective, voluntary, and nebulous standard of “freshness,” I wondered if it was … well, kind of a scam. After all, customers don’t benefit from throwing out foods; grocers lose money; farmers miss out on possible sources of revenue. The only people who could benefit are the producers, and I could imagine an unscrupulous manufacturer shortening the date on their food so that people will sigh, throw out a half-eaten package that has “expired,” and go buy some more.

I asked Emily Broad Leib, the director of the Harvard Law School Food and Policy Clinic and lead author of the 2013 study, about this. She laughed and said I’m not the only one to wonder if we’re just getting played.

But, she said, manufacturers would say “there is a legitimate reason on their part, which is that they want you to eat things when they taste the absolute best.” The methods by which they determine that date can vary; a big manufacturer might run a focus group with consumers to determine the date, while a small producer may just hazard a guesstimate. But importantly, the freshness date almost never corresponds to the food’s safety — to whether or not it could make you sick.

Suppose you buy a particular brand of yogurt, Broad Leib says, and it waits around till it’s slightly past its peak. You might decide you don’t like this brand of yogurt, and buy a different one next time. The dates are, in part, a way of “protecting the brand,” she said. Their biggest incentive is to make sure you eat the food when it tastes the way they think it should.

But that doesn’t mean that the way we buy and eat food has no part in the blame, and producers don’t have to be insidious to be part of the issue. The fact that so many of us read a “best by” label as actually saying “bad after” is partly a public education problem, and it’s one that manufacturers haven’t worked too hard to combat. “It’s in the general interest of anybody trying to sell anything to continue to perpetuate the illusion that our foods are going bad all the time,” Adler said. “We could buy half as much food.”

Adler noted that our penchant for buying more than we need and then throwing out food that’s gone slightly past its peak is rooted, at its core, in a consumer mindset. “The only way that makes sense is if your cultural value is unfettered growth and profit at all costs,” she said. “There’s no other way that it makes sense to just throw stuff out.”

In fact, she said, it’s in direct contrast to what most food cultures practice around the world. “The whole idea that mold and bacteria are to be avoided at all costs is not only antithetical to good cooking, but it’s literally not practiced” in most cultures. Salami and cheese and pickles and sauerkraut and all kinds of food come from the natural process of aging — “in most cuisines of the world, there’s not as great a distinction between new food and old food; they’re just ingredients that you’d use differently,” she said. Those traditions certainly have been retained in regions where Americans still make kimchi and half-sours and farm cheese. But we’ve absorbed over time the idea that those natural processes are bad and will make us sick. Instead, we rely on companies to tell us what food is good for us and when to get rid of it.

Adler says part of the problem may also lie with our burgeoning “food as status performance” culture, in which particular foods trend on social media, or food media coaxes us to keep buying new ingredients to make something we saw in a picture or on TikTok. “That doesn’t do a great service for anybody trying to cook what they have,” she said. “If they don’t have the ingredients for the viral thing, then whatever they do have is just going to sit there, while they go get the other ingredients.”

Our shopping culture is also at fault

The problem is bigger than individual consumers. Some states bar grocery stores from donating or selling out-of-date foods to food banks and other services designed to help those living with food insecurity. The thinking is reasonable, even altruistic: Why would we give sub-par food to the “poor”? If I wouldn’t eat “expired” food, why would I give it to others? Distributors fear legal threats if someone eats past-dated food and becomes ill (something that has rarely happened, but it’s still a looming threat).

That’s exacerbated by the way Americans shop. Think about it: How often do you see a shelf or bin or freezer in a grocery store that isn’t fully stocked to the brim? Supermarkets stock more food than they can sell, and that’s on purpose. Broad Leib told me that it’s common practice for supermarkets to plan for “shrink” — food they expect to be wasted. Shoppers in the US look askance at a shelf that isn’t fully stocked, or at a few potatoes left in the bin. “On the consumer side, you can understand,” she said. “You want to go to a store and have them have everything you want. And if you went in and they didn’t have what you want, then you’d go somewhere else.” We may not even realize it, but we’ve trained ourselves to see full crates of beets and shelves of salad dressing as a sign that the store is good, and therefore the food in it is good. Abundance indicates quality.

But that mindset naturally, even inevitably, leads to waste. In many places, if you can’t sell all your milk by the sell-by date, you have to dump it. Consumers don’t want to buy a box of Cheez-Its that only has a week left on it. Beef that “expires” in two days is not going to fly off the shelves. And if you can’t sell all your carrots, some of those carrots are going to start getting a little bendy. And many grocery stores will only sell produce that’s up to a certain aesthetic standard — no weird-looking apples or sweet potatoes from outer space, everything the same shape and size. Furthermore, if a manufacturer changes the label on their cookie packages, all the old packages will probably just be discarded to maintain uniformity.

“Most of the decisions that are made about most of the foods that we eat are made for reasons that have nothing to do with the food’s deliciousness or its healthiness or anything intrinsic to the food,” Adler said. “The leaves on vegetables wilt before the stalk on the vegetable, so it’s much easier for grocery stores to cut off the leaves at some point in processing. Otherwise you have to be sprinkling and trimming them all the time.” So the perfectly edible leaves of some vegetables may get lost in the process as well, while they could have been used to feed people.

Some businesses have cropped up to try to fix this larger-scale problem, like Misfits Market and Imperfect Foods. They form relationships with producers to rescue aesthetically “ugly” food — or at least, food we’ve been trained to think is ugly or too small or too large — and sell it to customers. They also buy food that’s approaching its label date and resell it to customers, hoping to cut down on food waste and change the way people eat. “It’s all about breaking down misconceptions,” Imperfect Foods’ associate creative director, Reilly Brock, told me by phone. “Food is not Cinderella. It’s not going to turn back into a pumpkin by midnight if it reaches the date on the label.”

But across the country, the standard practice for your average American consumer still stands. Make a big trip to the grocery store to buy your food from the glossy displays. When food expires, throw it out. Meanwhile, farmers are plowing ugly produce back into the ground or letting it rot in the field, and stores are chucking food that’s near or past its date into the garbage because there’s nowhere else they can send it.

Can we change this?

Why doesn’t the government just fix the problem?

The follow-up data to the 2013 Harvard study found that standardizing the date labeling system across the country — rather than leaving it to more local governments to address in a scattershot fashion — could be incredibly beneficial to the economy and to consumers. Enacting standardized legislation, it estimates, could prove to be an economic value of about $1.8 billion to the US. What’s more, an estimated 398,000 tons of food waste would be diverted to actually feed people, instead of sitting in landfills.

But fixing it has proven harder. Since the 1970s, Congress has periodically introduced legislation to modernize and standardize the system, in various forms. But, as Broad Leib told me, it can be an uphill battle. “The last administration and Congress were fairly deregulatory,” she pointed out. In the years since the 2013 study, many states have passed laws to try to standardize their own dates, even if they don’t align with other states. While Broad Leib and her colleagues argue that businesses (particularly national ones) would benefit from trying to meet one federal standard rather than different standards in different states, the philosophical differences can still be tough to surmount. “When you’re in a government that’s deregulatory, even for a good regulation, they say, ‘Let industry handle it. They have a voluntary standard, and we don’t need to step in.’”

Furthermore, Congress just moves slowly. “They don’t have a lot of stand-alone small bills,” she said. “So the best hope that this has of getting enacted is hitching itself to a moving train. A lot of our work has been in saying, ‘Here are other bills that are moving along’” — like the US Farm Bill, or the Child Nutrition Act — “and here’s why date labeling fits in with them.”

Quite a bit has happened in the years since Broad Leib and her colleagues first published their study. Seeing the problem, two major associations (the Consumer Brands Association and the Food Marketing Institute) put together a working group to design a standard date label that would work for both businesses and consumers. “They came up with a ‘best if used by’ label for a quality date and ‘use by’ for a safety date,” Broad Leib told me. “And they got a bunch of their members to sign on to voluntarily shift to using those dates.” In other words, if a food won’t decrease in safety but might decrease in quality, the manufacturer would use the “best if used by” label; if it might become unsafe to eat, they’d use the “use by” label. That system corresponds roughly to a standard used in many other countries.

This could make the work easier for the federal government to act, she says. “If Congress wanted to act, or the FDA or USDA wanted to act, it would be very easy to say, ‘Here’s what the standard label should be. We have some data on what works for consumers. And we know that these work for industry.” But otherwise, she calls the new label standard more of a “halfway solution,” since the label still will only appear on some products.

It’s more than laws. The culture needs to change.

And until there’s a better solution, the best thing we can do is try to educate ourselves and change the way we shop for food.

Broad Leib says there would be three big components to improving the system as it stands. First, the adoption of standard labels that indicate either a freshness date or a risk date would help.

But the second part is just as important: We need a public health program to educate people about what’s safe to eat. The UK has done a series of campaigns toward that end, with the slogan “Look, Smell, Taste, Don’t Waste,” in which it partnered with industry to help people understand when to keep their food and when to toss it.

The third component would be changing the way we allow food to be donated and distributed through food banks and other means. That requires a shift in how we think. If everyone is eating food past its “freshness” date — understanding that the food is perfectly safe but may not be at its absolute peak condition — then there will be less hesitancy about giving that food away, and less fear about the possibility of facing legal repercussions. That could have a huge impact on hunger and food insecurity in the US. “If everyone acknowledges that those foods are fine to eat, and everyone’s eating them, it’s not like, ‘Past-dated food is only for people who can’t afford food,’” Broad Leib said. “No, we should all be eating that.”

But that means we each need to rethink how we interact with food. We need to start trusting our senses to tell us if food is edible. “Use your sense organs,” Adler said. “We have them so that we can figure out whether things in the world are going to kill us, so we can make sure we’re not going to poison ourselves and die — and it’s even worth doing when you suspect something is bad, because feeling your body’s response is so reassuring.”

We need to ask for more clear labels, advocate for better legislation, and talk to one another about what labels really mean. And we need to move closer to food again, thinking of it less as a packaged consumer product and more as something natural that nourishes us as humans.

And in my case, that means I’m going to start sniffing what’s in my refrigerator before I chuck it — and maybe even turning it into lunch.

Strengthening WIC to improve health: A prescription for change

Originally written by Kathryn Garfield, Emma Scott and Cissie Bonini and posted on The Hill on 6/23/21.

We’ve all been told to eat more fruits and vegetables. But did you know that diets that are too low in produce are linked to cancerdiabetes, obesity and cardiovascular disease? Or that these conditions have become risk factors for severe illness and mortality from COVID-19? Or that, for children, an unhealthy diet can lead to problems in cognitive, language and behavioral development? Despite being a key driver of both health outcomes and health care costs, access to nutritious foods remains out of reach for many families.

How are we responding? 

Increasingly, public health experts and community advocates are calling on U.S. health care leaders to directly address the connection between food and health. They argue that by integrating services like produce prescriptions and medically tailored meals into patient care, we can better support people in managing a range of serious diet-related health conditions. While initial evidence is compelling, sustaining and scaling many of these “food is medicine” interventions will take time and change — including new approaches to insurance coverage and the technology to support nutrition referrals.

In the meantime, one existing program already has these key structures in place and is poised for immediate, widespread impact: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

What is the role of WIC?

Since the 1970s, WIC has worked to improve the health of low-income families by providing nutrition assistance to pregnant and postpartum individuals, infants and children for their first five years of life, when a child’s palate is developing and proper nutrition is particularly critical. Like other food medicine models, WIC is embedded in the health care system. Health professionals determine an applicant’s “nutritional risk” — an eligibility requirement alongside income thresholds and residency — and enrollees receive a prescribed set of federally-approved nutritious foods and health education each month.

Why is WIC falling short?

Today, WIC provides over 6 million participants with WIC food packages, one component of which is $9-$11 per month for women and children to purchase fruits and vegetables. Despite this support, WIC-eligible individuals are still less likely than higher-income individuals to meet dietary guidelines for fruits and vegetables. The reason? In part, because the WIC monthly allowance is simply too low to cover the costs of supporting the recommended daily fruit and vegetable intake.

According to the National Academy of Medicine, the WIC fruit and vegetable benefit would need to be $23-$45 per month (depending on daily caloric needs for the individual) “to meet [just] half of the recommended intakes of vegetables and fruits.” An increase from the standard WIC package has produced beneficial results. 

A growing body of evidence suggests providing financial incentives to support healthy eating, whether in the form of a prescription, voucher, subsidy, or other mechanism, can improve health and reduce long-term health care costs. An evaluation of the most recent revision to the WIC Food Package, which included the addition of the fruits and vegetable voucher, showed improved health outcomes for both mothers and their children.

In addition, these findings, Vouchers 4 Veggies-EatSF, a produce prescription program where one of us serves as executive director, examined the impact of providing an additional $40 per month in produce vouchers to pregnant WIC recipients, in partnership with the San Francisco Department of Public Health. Participants reported being more food secure and having a more nutritious diet. Data also suggested they were less likely to experience a preterm delivery — an experience that not only takes an emotional toll on the family and can lead to long-term health effects for the baby, but also can cost the health care system tens of thousands of dollars. Thus, ensuring adequate benefits for fruits and vegetables will be an important policy strategy to support better health outcomes and lower health care costs. 

Is there potential for change?

The last revisions to the WIC Food Package occurred almost 15 years ago, making change long overdue. This March, in response to the ongoing COVID-19 pandemic and increase in food insecurity, President Biden signed the American Rescue Plan Act of 2021 (ARPA) into law, allowing states to temporarily increase the WIC fruit and vegetable benefit to $35 per person, per month. In doing so, federal leaders followed the science and critically strengthened WIC’s ability to support families across the U.S. but only through September.

What happens after the pandemic? 

The height of the COVID-19 crisis may pass in the coming months. But the challenges of food access, nutrition and health are long-term issues that require long-term solutions. Even prior to 2020, one in nine Americans lived in a household that was food insecure, or unable to consistently access enough food for an active, healthy life. For households with young children, these numbers were even higher.

In a March 2021 report, the Center for Health Law and Policy Innovation of Harvard Law School (CHLPI), where two of the authors work, therefore recommended, among other policies, the permanent expansion of the WIC fruit and vegetable benefit to $50 per person, per month. Hearings are already underway for Child Nutrition Reauthorization, the legislation that typically includes WIC. This process presents an opportunity to seize on lessons learned from the pandemic and build bold, long-term policies to support the health of families across the United States.

By strengthening WIC we can take an important first step towards advancing the role of food as medicine and set the stage for broader change.

Kathryn Garfield is clinical instructor of Health Law and Policy Clinic at Harvard’s Center for Health Law and Policy Innovation.

Emma Scott is a clinical instructor of Food Law and Policy Clinic at Harvard’s Center for Health Law and Policy Innovation

Cissie Bonini is the executive director of the Vouchers 4 Veggies-EatSF.

Hilary Seligman is a professor of Medicine, University of California San Francisco.