January 19, 2013 by afrazzini
Prior to meeting people who shape food policy legislation and implementation on Capitol Hill, I was somewhat overwhelmed and intimidated by the whole subject of national food policy. I had tried many times to wrap my head around the farm bill, but never felt like I had all the pieces of the puzzle. After attending panels of speakers who have better perspective on the issues, however – many of whom had actually been successful in making changes to the system – I realized that nobody ever has all the pieces of the puzzle; we can only do the best with what we have.
Unfortunately, every policy has unintended consequences, and sometimes those may outweigh the benefits. But while we can and should work hard to minimize unintended consequences, professionals in a field as complex as food policy will never be able to avoid unintended consequences altogether. All we can do is simultaneously fight for the solutions we believe to be best and continue searching for better solutions. I was inspired by when I saw how ardently food policy advocates fought for imperfect solutions; I hope they are also genuinely searching for better ones. And I hope that as I start my career I, too, am able to balance both tasks.
I’d like to highlight one theme in particular that reverberated throughout the DC panels, which I believe will help policymakers minimize unintended consequences: citizen and community empowerment. “Empowered people” is one of the four directions of the National Prevention Strategy, and “Empowering caregivers” is one of the five strategies of Let’s Move. This trend toward empowerment-oriented programming makes me optimistic about the potential of new federal public health policies, because my professional experience in the field of social services taught me that no program can be truly successful if the target population doesn’t have some sense of ownership and investment in the program goals.
Creating programs that empower individuals and communities seems like an inherently tricky task for a national government, because each community faces unique barriers – and it is not possible to address every community’s barriers by requiring them all to enact a specific policy. But the beauty of recently-created public health programs, such as the Healthy Food Financing Initiative and the Community Transformation Grants, is that communities aren’t required to implement one specific “solution.” Instead, they have the freedom to develop programs independently according to their greatest needs, with the financial and technical support of the federal government.
Having worked with a local health department during the first year of a Community Transformation Project, I can testify that it is a challenge for many people working on the ground level to transition from their more traditional roles – such as responding to an urgent need or implementing a mandate – to this new empowerment-based preventive strategy, which requires more innovation, outreach, and collaboration. But the chronic disease trends of the past several decades are strong evidence that if we don’t find successful prevention strategies, our health system will be vastly overburdened. So even if our current preventive programs aren’t immediately successful, we must consider them a step in the right direction.
I am concerned, however, that the empowerment theme has not sufficiently filtered through to all of the new federal public health initiatives. For example, one speaker seemed to regard Walmart’s expansion into food deserts as a way to save economically depressed communities – not even mentioning what role the communities could have in their own revival. In reality, the sheer economic power of Walmart is such that communities quickly become dependent on it; when people can make one trip there instead of five different trips (to the bodega, the clothing store, the hardware store, the pharmacy, etc), they stop shopping at local business and those businesses shut down. One study of Walmart moving into a Chicago neighborhood found that 40% of all competing businesses within a one-mile radius of Walmart had gone out of business within two years of its opening. This is not what I would call an empowering trend, and in fact some cities have resisted Walmart’s advances for that very reason. Manhattan Borough President Scott Stringer produced a report outlining the harm that Walmart presented to the New York City food economy, and various citizens’ groups have protested the corporation’s proposed move into the city’s food deserts.
I realize that some communities are suffering so acutely from the recession that Walmart’s expansion into their area would do more economic good than harm – but if the government is helping Walmart achieve this expansion, then surely Walmart can agree to measures that will increase the community’s level of influence over the process. If every new store opening were accompanied by a Community Benefits Agreement requiring Walmart to pay its workers fairly and be a “good corporate neighbor,” maybe we could alleviate some of the negative consequences of Walmart’s business practices. Walmart has signed such agreements in DC; why not do it in every economically vulnerable area?
The idea of empowerment was also absent from the conversations about food labeling. Food manufacturers argue that by highlighting some nutrient data on the front of a food package, they can help consumers learn how to use that information. Yet as we all know, one of the biggest challenges of grocery shopping is the fact that there are too many options. When bombarded with hundreds of cereal boxes lining a store aisle, for example, most people find it impossible to weigh all of those options in terms of taste, healthfulness, quantity, price, packaging etc. Many people will, rather than examining all those features on every box, choose a default – the cereal they grew up on, or the one with their favorite celebrity on the packaging. By endorsing a “facts up front” nutrition labeling scheme, the FDA would be adding to the cacophony of information. Several of our panelists acknowledged that the government needs to go beyond merely educating the public on how eat healthfully, and actually help make the healthy choice easier – yet a “facts up front” scheme does not seem to do that.
If, however, the FDA created a system for rating the cereals in terms of healthfulness, and gave incentives to grocery stores that place healthier cereals in the most obvious locations, it would be easier for customers to know how to choose a healthy item. Then the government would truly be helping individuals overcome crippling information overload, thereby increasing our capacity to make healthy choices. Or we could use even more grassroots methods: rank cereal in terms of a number of parameters (e.g., amount of sugar, amount of fiber, etc) and let the customers of a given grocery store or chain vote for the parameter by which they want the cereal’s placement (in relation to the front of the aisle, or other preferred area) to be determined. Logistically difficult, but maybe possible in the age of text-voting.
Perhaps ideas such as these have already been considered and discarded, due to barriers of which I am blithely unaware. But I hope that more such ideas are in the works, because our national health will benefit from continued implementation of empowerment-oriented programming.
So to summarize, I am encouraged by the trend toward preventive and empowerment-oriented food policy, and I feel grateful to those who are fighting for the best of the imperfect solutions. I hope that people working on national food policy recognize the imperfections of current policy, such as the incomplete picture of “empowerment,” and continue the search for better solutions. As I enter the field, I must do the same – and I also hope to throw new ideas into the ring.
 Disclaimer: I realize that some people find the term “empowerment” to be problematic, because it implies that members of the target population are helpless victims. But for the purposes of this post, I will use the term as the federal government does: to describe programs that increase the capacity and motivation of the target population to make healthy choices.