Opinion | Science-Based Food Policies: What Works, What Doesn’t

Creating meaningful and relevant research-based food policies was the topic of a recent talk with policy and nutrition experts from across the United States.
Each attended the Global Summit on Food Security, organized by Kellogg Fellows Leadership Alliance (KFLA) and supported by W.K. Kellogg Foundation, with media sponsorship provided by Food Tank. What they had to say might surprise you.

Meet:
Holly Freishtat is Baltimore City’s first Food Policy Director. She created the Baltimore Food Policy Initiative, an intergovernmental collaboration that addresses food system policy. This was honored with the highest award for its implementation of the Milan Urban Food Policy Pact on World Food Day 2016. A Kellogg Fellow, Freishtat received the 2016 Medallion for Meritorious Service Award by former Mayor Stephanie Rawlings-Blake and was honored among Maryland Daily Record’s Top 100 women.

Mondi Mason, Ph.D., MPH, is a Food Policy Program Administrator in the City and County of Denver’s Department of Public Health & Environment. She works closely with local and regional partners on food system policy development and programs to increase access to healthy, affordable food. A Kellogg Fellow, Mondi has more than 25 years of experience in community-based public health research.

Lorrene Ritchie, Ph.D., RD, is the inaugural Director of Nutrition Policy Institute (NPI) and Cooperative Extension Specialist in University of California’s Division of Agriculture and Natural Resources. NPI’s mission is to improve nutrition and reduce obesity, hunger, and chronic diseases in children and families. Dr. Ritchie has devoted her career to developing interdisciplinary, science-based, and culturally relevant solutions to childhood obesity. She has researched the impact of nutrition policies and federal, state, and community-level programs.

How can research-driven solutions better direct healthy food policies?
Mason:

“Research can illuminate and shine the light on food policy priorities for communities, policymakers, and cities. When I’m talking to policymakers in the City Council or Denver mayor’s office, some of the first questions are, ‘Who else is doing this? What do we know about this issue?’

That’s where research comes in handy. We can demonstrate there is evidence-based information by examining what other cities around the nation and world are doing. If we can demonstrate there have been changes or economic impacts, that’s what policymakers want to know right away.

We work with community members, food-focused organizations, and the Sustainable Food Policy Council in Denver, which is a mayoral commission to advise on food policy issues. We’re partnering to continually inform what Denver needs and what people in the neighborhoods really want. That provides some comfort to policymakers because they don’t want to adopt a policy and then have pushback or negative press. Research is a critical piece of the picture and helps to lay the groundwork for the next steps.

When we adopt the policy, we want to continue the research and evaluation of that policy. How did it increase food access? From a public health standpoint, we want to know about population-level health impacts. Does it help to reduce chronic health issues in our residents?”

Freishtat:

“Mapping is a language our elected officials can understand very quickly. In Baltimore, we’re collaborating with the Johns Hopkins Center for a Livable Future. They are intellectual petrol. They are the ones doing the research to identify areas where Baltimore City residents may have challenges accessing healthy foods. They work with my office using Census data and other information to show areas of concentrated food access barriers. So, together we are laying the priority areas for healthy living planning.

The university research is important because we don’t have the time and money to do it. But we can take that data, and transform it into an effective way to drive food policy. This is a true collaboration. If you look on the maps, you’ll see Johns Hopkins University and all Baltimore Food Policy Initiative members listed on each one, so everyone can use these maps.

It’s not about forcing these maps on to communities. But we need the maps because I need to move them up the system so that policymakers will allocate resources and understand why this is important.

I don’t think these maps are the right tool to go into communities to have people engaged and empowered. Residents and community groups need to decide if they want to use the data, how they want to use the data, and whether they want to use their own data. But as long as we are working together towards common goals, we can move forward.”

Ritchie:

“Through dozens of research projects at NPI designed to inform policy and environmental change, we’ve learned that it takes partnerships. As researchers, we know a lot about study design, data collection and analysis, and dissemination of results to other researchers. We know much less about how to present that information to decision makers and policy makers. The way we have had the most impact with our research getting into the hands of legislators and decision maker has been by working with advocacy organizations.

For example, our collaboration with California Food Policy Advocates has been incredibly productive. Ten years ago, they came to us saying, ‘We want to do more work in childcare. We think the youngest children are the ones to reach.’ Our researchers had been studying this area. We knew by the time kids get into kindergarten, over one in five are already overweight and obese. Their nutrition habits are largely established. We knew we should be focusing more attention on younger kids. Ideally, we should be starting even before birth.

These advocates asked, ‘What’s nutrition like in childcare?’ In 2008, nobody knew much about this topic. There had been almost no studies of what the nutrition environment was like in childcare. So, we did the first statewide survey in California. The short answer is that in childcare there’s lots of room for improvement. Using that connection with the advocates, we developed a model for how to disseminate our research to have an impact.

The process involves not just having quantitative data, where there are lots of numbers and statistics. Decision makers want numbers. But we also married that with qualitative research. So, we had the stories as well. As much as we love data, as scientists and decision makers, we also want to hear the voices of our constituents. Policymakers especially can be moved to action by those stories. They want to hear from people’s hearts how a new policy or program will impact them.

Another key component is to invite stakeholders to the table. Invite the people who operated childcare programs at state and local levels, who were the changemakers and influencers, who could actually make child care nutrition changes happen. Instead of us academics saying we think you should do this, we really need the help of the people on the ground to identify the next policy steps. Therefore, we presented both the quantitative and qualitative data we had collected and we asked them to tell us the solutions. In our experience, this approach has made change happen a lot more easily.”

Some of the biggest obstacles?
Mason:

“What often captures the imagination of a policymaker or community member are strategies that don’t necessarily have the evidence they will truly impact access to healthy food. This is especially true with population-level programs because we’re thinking about at least a neighborhood or larger number of people.

We work with these stakeholders to determine the best approaches for tracking new policies to ensure they’re having the intended outcomes we want. Often, strategies take a long time to pass, even a decade or more. Right now, Denver is working on a neighborhood planning initiative, which is an accelerated process to create neighborhood plans or updated plans (some haven’t been updated in 20 years) and many which include food strategies. Some community members already have food strategies that we want to integrate into the process. These plans essentially codify what’s to come in that neighborhood, but it takes time.

Some communities want grocery stores in their neighborhoods, and there have been local and state incentives created to attract retailers. But these grocery retailers are making these business decisions and have plans detailing when and where they are going to build stores. By working closely with the community, we can hopefully help people understand that we have some mechanisms to incentivize grocery retailers but we don’t have all the answers, nor can we force a grocery retailer to open a new store.

Another challenge is when public health officials say, ‘We have these dollars to work on child obesity.’ But maybe that’s not a community priority, which might be as basic as getting new sidewalks to walk to the grocery store. It’s not always a priority to work on childhood obesity per se. Public health professionals and academicians need to find a starting place to meet the community where it actually is.”

Freishtat:

“An obstacle is always going to be what data and methods should be used to measure food access. Being able to use multiple frames of data and figuring out how they come together is important. The challenge and opportunities are balancing the desire to measure changes over time, but also applying new methodologies with new metrics as we continue to learn and evolve.

In 2010, Baltimore City had one definition of a food desert, but then it was changed the next year to be more accurate and reflective of the realities in our city. So, researchers couldn’t compare data over the two years. Then we changed it again. If a definition keeps changing to make it relevant to politics and policy, it makes it hard to see change over time. We’ve done a good job of developing these maps with Johns Hopkins in our 2018 Food Environment Map and Report, but it will continue to evolve.

This can’t be stagnant data. I can’t give you a 20-year analysis of how food deserts and food priority areas have changed in Baltimore because, otherwise, we couldn’t be responsive to the city’s needs. Every time we release a report with Johns Hopkins, we work on it for more than two years before releasing it.

Another challenge was the term ‘food desert.’ During the Obama Administration’s Let’s Move campaign, Baltimore was one of the only cities who had a city-issued food desert map. That meant we had access to federal funding that other cities did not. Our food desert map mirrored and mimicked the Obesity Task Force report that went to President Obama, and reported all the work Baltimore was doing. We knew some community members and advocates took issue with the term food desert. It’s not a desert. There’s food. It may not be healthy. But there is food. We knew that in 2015. But we needed the maps to remain eligible for funding.

Our data doesn’t just show supermarkets. It shows unhealthy food environments. The Healthy Food Availability Index shows the presence of healthy food in our retail stores. Not just where the supermarket is located. It’s more nuanced. But after the 2016 presidential election, we realized there wasn’t a reason to keep the term ‘food deserts,’ because there isn’t funding associated with this term any longer.

We engaged residents, equity advisors, and Baltimore food heroes like Eric Jackson of Black Yield Institute and Pastor Herber Brown of Black Church Food Security Network, who use the term ‘food apartheid.’

There were African American leaders who did not want the name to change to ‘Healthy Food Priority Areas.’ But we’re using these tools for government, and this new name encourages city, state, and national funds. This new name says what it is. We use it for our government strategies, but citizens can call these priorities whatever they want. Let’s just get money directed towards these priority areas.”

Here’s more on food deserts and food apartheid.

Ritchie:

“Language can be a challenge. When we started with California Food Policy Advocates, we had to learn each other’s lingo. Not just words, but how we viewed things. For example, as a researcher, I can tell you what we’ve learned after a study. But I will always follow with ‘but.’ But…we don’t know if this applies to other populations. But…we don’t know if this relationship will translate into other contexts. That’s not what an advocate necessarily wants to hear. They prefer a simpler sound bite.

Another obstacle is time. In my world, we have a hypothesis. We do a literature review. We generate research questions. We write a grant proposal. We get funded and get a contract in place. We design the protocols. We pilot test the protocols. We collect the data. We clean the data. We analyze the data. We write up the results. We’re usually talking several years of work.

But advocates are on different timelines. Who knows when decision makers will get reelected or onto the next hot topic? They have to move quickly. We had to learn to not only speak each other’s language but coordinate with each other’s timelines.

For example, I might start a study but the final results may not be published for several years. That’s a long time for advocates to wait. We had to learn to write research briefs, so we could provide enough sound information that they could use, but we could still publish. As academics, our currency is publishing. In this way, we are able to give them the data they need without sacrificing our ability to publish.”

Importance of community support?
Mason:

“Engagement is key in Denver. We partner with community organizations, food-focused groups (including food pantries), producers, distributors, farmers’ markets, and food equity organizations. We work with the Sustainable Food Policy Council, and all appointees represent different organizations. The Department of Public Health & Environment provides the administrative support for that body, and we work closely with them to bring their food policy advisories to the mayor.

In Denver, policymakers want to hear from constituents. We hold listening sessions and Town Hall meetings with neighborhood organizations. We must talk to a certain number of constituencies, such as registered neighborhood organizations, before moving any kind of policy forward. There are always public comment opportunities.”

Freishtat:

“My job is helping government support communities to do their work on food. It is not my job to tell the communities what to do. The communities will inform and help us, but they can only be effective if the doors are open.

My strength is working with 15 different agencies and helping those on the ground. There are three of us in my department. There is no way we could go to every community meeting. What I can do is help the government think about food in a different way, or open up different perspectives about how they could be engaging with communities. That way when the community reaches out, they can be heard.”

Ritchie:

“Our approach is to invite them to suggest the solutions.

The value is not only that the community is already supportive of the idea, but the community is much better at knowing what they need and what they can do. It becomes a cycle. We feed each other, as opposed to a disjointed and siloed way of doing things.”

What gives you hope?
Mason:

“We’re thinking of food policy, systems, and environmental changes in a broader sense.

Perhaps you never thought of food beyond how it nourishes your body. You may not have noticed that there are neighborhoods in your community that don’t have easy access to nourishing, healthy foods.

By connecting this issue to policy, transit, academic achievement, fair wages, land ownership, and climate change, we’re inviting more people to the table. I see food policy and systems changes as a mechanism by which we can start moving the needle on food, but also on other types of injustices in our communities. It makes me hopeful we can make a change and move towards a more equitable and just society.”

Freishtat:

“What gives me hope is that no one ever said that healthy food access is not a problem in Baltimore. Nobody ever told us that our data are wrong. The mayor, City Council, community members, and private sector foundations have all recognized this is a priority. Everyone is willing to work on this effort. How we work on it will continue to evolve. It’s not just food access. It’s also food equity, urban farming, food retail, the whole spectrum.”

Ritchie:

“We’ve been doing this work in the context of huge amounts of social and political change. What gives me hope is that I’ve seen a new rise and interest in civic participation.

We have to break down the walls between science and politics. Everything involves politics, and everything involves science and evidence. You hope that all policy is based on information gathered credibly and rigorously.

We have young people coming into research saying, ‘We want to be changemakers.’ When I went to graduate school, I was not taught how to write a policy brief. The concept of putting my data into a policy format and intentionally using it to inform policy was a foreign one.

But the next generation of researchers is better equipped to do this. They are already engaged and focused on the bigger picture. They are thinking, ‘Yes, I can be a changemaker. I want my data to create change.’ That gives me tremendous hope.”