If you feel like your grocery budget just doesn't buy you as much as it once did, you're not alone. According to U. S. Bureau of Labor Statistics, food prices rose 11. 4 percent last year alone - the highest annual increase in 23 years. The ongoing pinch at the grocery store has been in the news of a lot of media outlets, such as The Wall Street Journal, The New York Times, Times Magazine, Forbes, and so many others. Our guest today, food economics and policy professor David Ortega from Michigan State, is going to walk us through the food price inflation phenomenon.

Interview Summary

We've been hearing a lot about food price inflation. Can you tell us how food prices have changed over the last four to five years, and how that compares to the recent past?

Definitely. So, I think it's always really important to define what food inflation is so that we're all on the same page. We hear this word a lot and we've been hearing it for a number of years now. Inflation is the rate of increase in prices over a period of time - so how fast prices are changing or increasing in a given period. The time frame here is very, very important. Now, compared to last year, food prices are only up 2.1%. And this is for all food, which includes food at home and food away from home. Now groceries, food at home, are up 0.9% compared to last year. And menu prices at restaurants, or food away from home, are only 4.0% higher. Now if you're listening to this, you're probably thinking, ‘well, how can this be given how expensive things are at the grocery store?’ And that's because you are likely thinking about how food prices have changed since the start of the pandemic, right? So, over the past five years, food prices have increased around 26%. And so that's the cumulative effect of inflation that we're all very familiar with at the grocery store.

Wow. You talked about the recent past, and in particular, about the time since COVID. How has this looked historically if you take a longer time frame?

Yes, so if we look at a few years before COVID, food prices generally increase around 2% or so, year over year. Now in the summer of 2022, we experienced double digit increases in food prices. More than 11%, year over year. And that was the highest rate of increase in around 40 years, since the late 1970s and early '80s. So now that's a significant spike and departure from what we would consider to be normal. But the rate of increase has come down to almost pre pandemic levels, which is really great news. But remember the rate of inflation is the rate of increase, so because that rate has come down, it doesn't mean that prices are decreasing necessarily.

They're just not growing as fast as they were before.

Correct.

I have some ideas, but I really want to hear you talk about it. What has led to this significant increase in the last four and a half years or so?

It's really been a convergence of factors. It's not just one particular thing, but really all these factors coming together and sort of compounding on each other. We saw increases in labor costs, and then as we go through the timeline, we had Russia's invasion of Ukraine in February of 2022. And that really sent commodity prices surging for things like wheat, other grains, as well as vegetable oils. And it wasn't just the invasion alone, but we had countries responding with export restrictions on things like palm oil that really just exacerbated the situation. We also have the impacts of climate change. The summer of 2022, and for a few years leading up to then, there was this mega drought in the West and the plain states that affected anything from lettuce prices to the price of meat. Something that we're experiencing to this day. We also have the bird flu outbreak, now the largest outbreak in U. S. history. Egg prices have been through a bit of a roller coaster ride, and we've been hearing a lot about increases in egg prices. That's primarily due to the high path avian influenza outbreak, or the bird flu outbreak.

Now, those are all what I would consider, for the most part, to be supply side factors. But we also have demand factors at play. And that is, that when we look at consumer spending on food, especially over the past two to three years, it's been much higher compared to before the pandemic. Even when you adjust for inflation. Now, this is likely attributed to households. Some of them accumulated savings. We had the fiscal stimulus payments from the government that injected cash into the economy. For a period of time, some households, we could splurge at the grocery store. We've seen, and the data from USDA shows, that consumer spending on food both at home and away from home is much higher in recent years than prior to COVID. So again, it's a combination of both supply side and demand side factors that have contributed to the significant rise in food prices.

This is a really important point that it's not a single factor, but it's this mix of things, which also makes it really difficult to talk about how to disentangle it. And I definitely want to hit on that. But before we get there, I want to know what has the impact of these significant price increases on consumers been?

The first thing that I want to point out is that food price inflation doesn't impact everyone the same. It's really low-income households that are hurt the most by these price increases. And that's because they spend a higher share of their income on food. When we look at the poorest 20% of American households, they're spending over a third of their income on food, compared to the average American household that spends roughly 10 to 12%. Now, when we look at industry data, we see that as a result of inflationary pressures, individuals are making shorter and more frequent trips to the grocery store. They're doing more price comparisons. They're turning and buying more of the private labels, the store brands, that sell at a much more affordable price point. And they're buying fewer premium items. So less of the stocking up that we saw at the beginning of the pandemic. But this in turn can also fuel an increase in the price of those conventional or cheaper items. And that's something that I found in the research that I've done on egg and poultry prices. When prices increase, consumers switch to the cheaper, more conventional items. And that increase in relative demand can put upward pressure on prices. So, we've seen this also reflected in the way that consumers are shopping for food and the prices that they're seeing.

I think this is really critical for us to appreciate that while it is an often talked about issue, price inflation, and it does hurt lots of people, but appreciating that lower income folks are facing this at a much harder way is important. And, having spent time working with the charitable food sector and understanding the experiences of the individuals there, you're regularly hearing people talk about the high price of food and how they're trying to navigate it. And the role that these food pantries can play in helping meet that need, but it just still it's a grind. It becomes really challenging.

Yeah.

Recent economic data actually shows that food price inflation is moderating. So, it's not as hot as it once was. But consumers are still experiencing sticker shock at the grocery store. What's going on here?

So, coming back to the earlier part of the conversation, people are really feeling the cumulative effects of inflation. And again, that's why I find it very important to define inflation as the rate of increase in food prices. Well, the average consumer at the grocery store shopper, they don't really care about the rate of increase. They care about the price level, right? When you see that eggs are $3-4 a dozen that's going to catch your attention. When we look at the last 4, 4.5 years, food prices are up 25%. That's a significant increase.

Now, another reason for this disconnect in terms of what the economic data is telling us and how consumers feel about food price inflation, is the nature of food prices in our interactions with them. We see food prices on a weekly if not more frequent basis. We know when prices are going up. We encounter food prices, we go grocery shopping, much more frequently than we get a haircut or we buy a plane ticket. We see these prices rise. Now, it's also important, coming back to this discussion on the percent increase versus the price level, a 2% increase today is a higher dollar amount than it was a year ago, and certainly 5 years ago. Because the base has increased. It's not just in the consumer psychology. It's when we look at the price level and the increase. Prices are increasing more in terms of a dollar amount today than they were in the past. And so because of this, in many ways, the grocery store has really emerged as the face of inflation here in this country. And it really has impacted just about everybody over the past four or five years.

As someone who hasn't had a haircut in probably 10 years, I really do know that prices have changed fairly quickly when it comes to food. But I don't know what's happening at the haircut. But I really appreciate this. And, but I think the thing that a lot of people struggle with in this conversation is, but inflation is coming down. We've just heard these reports and why aren't food prices going down? But you've made it clear. It was almost like we've reached this high level. It is hard for it to roll back. I mean, we don't expect prices to actually fall, do we?

When we look at specific items, right, it's not uncommon to see, say, the price of eggs decrease when we have a period of low bird flu activity. But by and large, when we look at food as a category, say groceries, there have been some periods in the recent past where food prices decreased, say, 1-2% year over year. But we shouldn't expect prices to decrease to the level that they were before COVID. And that's because the nature of prices. They generally increase from year to year. And that's a good thing as long as they are moderate increases. And as the data have been telling us for a couple of months now, we're looking at food price increases in the neighborhood of what they were prior to the start of the COVID 19 Pandemic.

This is helpful. And it kind of makes me think of something we were talking about earlier. And so I want to ask you this last question. There's been some conversation in policy circles about addressing this problem of food price inflation. What are your thoughts on how policy could be used to make a difference in this situation?

That's an excellent question. We're coming up on an election and there's been proposals on both sides floating around and I appreciate the focus on an issue that is affecting consumers. But we have to look at the policies and what economic theory can tell us about what's going to happen.

The first thing I'll say before I even get to that is that the President of the United States, policymakers, have very little control over food prices, especially in the short term. We really have to look at sort of the longer time horizon. How can we make our food system more resilient to future shocks? Investing in crops that are drought tolerance, right? That climate change is one of the factors that's going to be with us from here on out into the foreseeable future. We have to make those investments now so that we have a much more resilient food system in the future.

In terms of coming back to policies, we have to look at economic theory. There's been proposals to ban, say, a price gouging at the federal level. That's something that I think we have to look at very carefully because there could be some unintended consequences. This is just straight out of Econ 101. Other candidates have proposed tariffs across the board. We've seen what happened when we had the trade war with China back in 2018. It leads to even higher increases in food prices because food producers, food manufacturers, rely on inputs oftentimes from abroad. And so now they're facing higher prices, they're going to be passed on to the consumer. As we look at policies, I think it's really important to look carefully at what some of the outcomes may be so that we don't run into some unintended consequences.

BIO

David L. Ortega is a professor and the Noel W. Stuckman Chair in Food Economics and Policy at Michigan State University. His research program focuses on understanding consumer, producer, and agribusinesses decision-making to better inform food policies and marketing strategies. Dr. Ortega provides timely analysis of forces and events affecting the agricultural and food sectors. He has been called to provide expert testimony before federal and state agencies, including the U.S. Senate and House agriculture committees. He is a frequent contributor to food price inflation reporting at The New York Times and NPR, and is regularly interviewed by prominent media outlets, including ABC News, NBC News, PBS, USA Today, CNN, Forbes, Politico, The Wall Street Journal, Financial Times, Newsweek, and the Detroit Free Press, to name a few. Dr. Ortega earned his Ph.D. in Agricultural Economics from Purdue University.

When we talk about problems with food insecurity and the food system, we tend to reference challenges at the national or international level. And of course, work at that level really needs to be done. But increasingly, there is a unique focus on regional food system strategies and right sizing solutions to best fit those unique characteristics of a particular locale. In today's podcast, we will talk with Rachel Sabella, director of No Kid Hungry New York. She leads the planning, implementation, and evaluation of the No Kid Hungry campaigns across the state of New York.

Interview Summary

Rachel, it is such a pleasure to have you with us on the show today. We've done several podcasts with No Kid Hungry staff in the past and discussed topics like your Summer EBT Playbook for state governments. I'm really interested to learn more about your work in the state of New York.

Thank you so much for having me, Norbert. We have been so lucky to have No Kid Hungry on here to share the stories. And I'm excited to give you some updates about what we've learned with Summer EBT, and to talk about how things look in New York these days.

So, can you help our listeners understand more about No Kid Hungry New York as an organization? What is your approach to addressing childhood hunger?

No Kid Hungry is a campaign of Share Our Strength. And I have the honor and privilege of representing the organization across the state of New York as we work to create solutions, to draw more attention and awareness, and to help connect more kids and families with meals. We believe that every kid needs three meals a day to grow up healthy, happy, and strong. But too many children, and I know we'll talk more about this, are missing those meals. We really take an approach of working directly with communities. I don't know the right answer for each community. But my job and really my privilege is to work with school districts, with elected officials, with community organizations to look for challenges and work together to overcome them and really change systems.

I can appreciate that local communities look very different and appreciate if you're talking about New York City versus upstate New York. Can you tell us a little bit about how you all think differently about the cities versus the more rural areas of New York State?

I appreciate that question. I think all of my colleagues can hear me say, we almost run two different campaigns in New York. Because the approach in New York City, where there is one school district in five boroughs, but a large concentration of students, the largest school district in the nation, versus the rest of the state, is different. But ultimately, the challenges are the same. How are we communicating with families? What solutions are out there that we can implement? We really focus on listening, sharing tools, sharing toolkits, thinking about, in some communities, what they need are materials translated in different languages, so families understand that SNAP benefits are available, or summer EBT benefits. Or as in other communities, it's how can families get to a centrally located place to pick up meals? We really spend our time learning and listening and sharing these programs so that they can find the solutions that work best.

This is wonderful. I grew up in Georgia, I should just note. And I grew up in rural Georgia versus Atlanta. And we always talked about two Georgias, the Atlanta region versus the rural areas. And I can appreciate just how different some of those challenges are. But you're right, the central issue of access to food is similar and how you address those issues will look different in those regions.

I want to span out and talk about some national data that just has come out. USDA has reported food insecurity rates in the U.S. and we saw that hunger actually increased. And we see that for childhood hunger, food insecurity in general, it has risen since the 2019 pandemic. Why is this happening for children?

It's a challenging time. I think something that came out of the pandemic was right away, people said, families are struggling with hunger. What can we do? The stories on the news. We saw it no matter where you were in the country, with the lines to pick up food. And we saw government responded very quickly. There were expanded SNAP benefits. There were no cost school meals provided to every child across the country. We saw pandemic EBT implemented. We also saw the expanded child tax credit. At a time when families were facing tremendous challenges, there was that support from the government. But many of those programs have now ended. And in these economically challenged times, incomes haven't changed. Some people are still dealing with an unemployment crisis. We hear a lot from families as well that they're underemployed. There may be a job, but it's not that same income. And without these expanded government programs, families are facing challenges.

How is this looking specifically in New York State? Are there specific challenges happening in the state?

I think so, and we have specific challenges in New York, but as we talked about earlier, I think we see every state is facing that. In New York State right now, hunger rose for child food insecurity. We're looking at one in five children in New York State. If we look at New York City, it's one in four children could face food insecurity this year. I often say that hunger hides in plain sight because I hear from people, well, they have a house. Well, with a set budget, they're paying to keep that roof over their heads, they're paying for their electricity bill, and what is the number that can shift in the budget, unfortunately? It's for food. We did a survey earlier this year, and four in five families in New York State found that it became harder to afford groceries. Their incomes just were not remaining at the same levels. And in those surveys, when we dig in a little bit, it was highest in rural communities and parents of school aged children. They are fighting hard for their families, but with all these economic challenges, as a society, we have to do more to help them.

Thank you for sharing those insights. And I remember early in the pandemic, some colleagues at Tufts and I did a qualitative study talking to families who were using little free pantries. Those ‘lending library boxes’ where people were putting food and one of the stories that we heard that kept coming up was. It was about price inflation, which was interesting because this was at the early part of the pandemic, and we did worry what happened to those families as inflation increased. And this was before some of those policies came into place about summer EBT and other food assistance programs. But now that those programs have gone away and inflation is starting to let up, but it's still a challenge for families. I really appreciate the way the campaign is thinking about these issues. You've already mentioned earlier that the No Kid Hungry team has worked on the summer EBT playbook as you prepared for a national launch of that program. Could you first just give us a brief overview of what the playbook is and then how has the rollout gone in New York State?

Even to take it back a step, Summer EBT was a new program launched this year. Every state was eligible to opt into this program, which provided a grocery benefit for eligible children and families. Before this, it was available in certain states that were part of a pilot, and No Kid Hungry had been advocating for this to be nationwide. We also knew that there was going to be a short amount of time for this program to launch. So, what we did was bring all our tools and resources together, our staff members, and we said, what do states need to implement? We partnered with organizations like Code for America, like APHSA, and to really see what is this? So, is it tools to get the word out about the program? Is it about implementation? Is it connecting states that face similar challenges to learn from each other? What the state agencies did this year to implement this program in year one, in about six months, was pretty unbelievable. And we also hope that as we're learning from this, we're going to see even more exciting changes in year two.

In terms of New York and summer EBT, we have been seeing so thrilled to see the uptake of the program, the outreach and awareness for summer EBT in New York. In August, Governor Hochul convened an event to celebrate the launch. We had members of Congress, we had No Kid Hungry, we had families there talking about this program. We heard from families how challenging the summer months have been and how this made that difference to get meals to kids.

We've been working with the New York City Council on doing trainings for staff members. So many people trust their local elected official’s office to get answers. How do I get a new card? How do I check my balance? We are learning a lot, we're seeing materials in different languages, and again, what we're excited to do is recap year one, and how do we learn more and make it even easier for families to access in year two?

This is amazing work, and I, I know it's really a challenge when folks, if you will, leave money on the table. And so, helping people connect to the resources that they have legal rights to is a critical role that you all are playing. What do you hope will happen as you learn from the playbook as it was applied in New York? What do you hope to share with other states in this process?

We want to show other states our best practices, what worked really well, what's something that we would tweak a little differently. We also want to make sure that those states that weren't able to opt in this year, because there were more than 10, I think about 15, that did not opt in. We want them to see what they can do and how they can use this program to connect kids with meals. But also, this money is reinvested in local communities. Families are using it at grocery stores, at local markets. In New York, we're really excited to see how they're using it at green markets, getting those fresh fruits and vegetables, supporting agriculture. This program while it addresses hunger, it's also an economic engine. And we want to make sure everybody understands that and are using those dollars in a valuable way.

I want to ask you a last question, and it's sort of a big question about child hunger. So, what is the outlook of child hunger in New York, and what gives you hope about addressing this challenge?

One of the things that gives me tremendous hope Is when we did our survey of New Yorkers, 93 percent of New Yorkers believe that solving childhood hunger should be a bipartisan issue. They don't see the politics of this in New York. We have seen that increasing the SNAP minimum benefit is a bipartisan solution. We have seen no cost school meals for all children has bipartisan support. I think we see New Yorkers recognize they want to make a difference. We get questions all the time. How can I help? We have media outlets sharing the deadlines, putting the updates out for families. We see elected officials in New York State that are paying attention to what's happening in their backyards and their local communities. And they want to make a difference. I hope that what we are seeing in New York translates into other states, translates to the federal level. There is an excitement right now around school meals, and we're hearing a different dialogue. It's something that people like you and I, we know the difference it makes, but I'm hearing from family, from friends, 'Rachel, I read this story on School Meals," tell me about this. My hope is the excitement, the enthusiasm and the interest really changes the conversation and helps us drive forward solutions that will ensure that someday there is no kid hungry.

BIO

Rachel Sabella has been a respected advocate, strategist and leader for nonprofit organizations for more than 20 years. She has been the Director of No Kid Hungry New York, a campaign of Share Our Strength, since 2018. In this role, Ms. Sabella works closely with stakeholders across New York State to ensure children have access to the nutrition they need to grow and thrive. She oversees grant-making, awareness building, programmatic and advocacy priorities for No Kid Hungry New York and manages relationships with state and local policymakers. Since March of 2020, she developed and oversaw a strategy to distribute more than $9 million in emergency grant funding to organizations across the state of New York and Puerto Rico to connect more kids and families to meals. She has led successful advocacy campaigns at both the city and state levels on issues including expanding access to school meal programs and SNAP in order to connect more New Yorkers with meals. Ms. Sabella also serves as a member of the NYS Council on Hunger and Food Policy and was appointed to Mayor-Elect Eric Adams’ transition team. Prior to this role, Ms. Sabella served as the Director of Government Relations and Policy for the Food Bank For New York City. During this time, she led advocacy campaigns to grow and strengthen resources for anti-hunger programs, which led to unprecedented support for food pantries and soup kitchens in New York City. Her advocacy efforts also led to the creation of 25 school-based pantries that distribute food, menstrual and hygiene products, and household cleaning supplies to families in need.

Today we discuss a new and provocatively titled book written by Southwestern Law School professor Andrea Freeman, an expert on issues of race, food policy, and health from both legal and policy perspectives. The book's title, Ruin Their Crops on the Ground, the Politics of Food in the United States from the Trail of Tears to School Lunch, has been called the first and definitive history of the use of food in the United States law and politics as a weapon of conquest and control. Freeman argues that the U. S. food law and policy process has both created and maintained racial and social inequity. She documents governmental policies from colonization to slavery; to the commodities supplied to Native American reservations. She argues that the long-standing alliance between government and the food industry has produced racial health disparities to this day.

Interview Summary

Let's talk about the title of your book. What are you trying to communicate?

So 'ruin their crops on the ground' is a paraphrase of what George Washington ordered his troops to do, to try to displace Indigenous people and take over their land.

That's a pretty powerful image to think about that. So, in your book, you use the term food oppression. Can you explain what you mean?

Yes. So I originally started writing about food oppression as the alliance between corporations, the food and agricultural industries, and the government that [00:02:00] create stark health disparities on a racial basis, sometimes gender and class. And as I've come through thinking about this over the years, I'm also using it to describe the way that food has always been used as a tool of subordination by the U.S. Government in history.

An interaction between the industry and government isn't inherently oppressive. How does it come to be that way? I mean, it could be good, good for the public, it could be bad, but why does it, how does it become oppressive?​

Yeah, I agree that the problem with the food industry is that the desire to make profits is in conflict with the nutritional needs of people that the U.S., Government programs focus on nutrition are supposed to be serving.

Let's go back to some of the earlier times. You've written about the role that food played in slavery. Could you explain?

Absolutely. So, enslavers were very careful about the portions and the type of food that they gave to people. the people that they enslaved. And they would write pamphlets and advise each other. Hoping to find a balance to give enslaved people enough food to be able to work and be alive, but not enough to give them the energy to revolt or perform acts of resistance that they inevitably did. And then food was used to create hierarchies within enslaved peoples. It was used to, I don't know, take away pleasure, really, from life to oppress people in so many ways. And so, not just from the content of the food, but even the way that food was delivered. So, instead of eating on plates, food might be poured into a pig trough or scattered on the ground, right? There are so many ways that enslavers used food to try to degrade and subordinate people through either the portions or the content or the delivery.

Food is such a fundamental and kind of elementary form of reinforcement. You could imagine it being used to punish particular individuals and reward others.

Absolutely. And the law backed up the way that enslavers used food. And even when enslaved people wanted to grow their own food, and perhaps sell it to gain some advantage, the law prevented that. Enslavers might just take over those gardens. Steal the food. Use it for their own purposes. That was all perfectly legal. And the law tried to protect other enslavers from having enslaved people come and steal their food by having some laws in place that said, you must give adequate provisions, which looked like something that might protect enslaved people, but in fact was only to protect other enslavers.

Going back to the title of your book, it makes reference to the Trail of Tears. And people have highly varying levels of knowledge of what the Trail of Tears refers to. In North Carolina, it's a really important and tragic part of the state's history for the native individuals living in the western part of the state. But could you tell us more about how food figured into this, what it was and how food figured in?

Of course. So the United States wanted the land that Indigenous people were living on. And they designated a part of the country that covers Oklahoma and some states around there and called it the Indian Country or Indian Territory. And to try to force indigenous people to move to that land and to make a journey across the country that was so dangerous, and ended up killing maybe half of the people who made that journey, they destroyed the food sources of people. They had no choice at all. They were starving. They either had to go or die there with no food. And food played into the promises that were made by the United States government of rations that would be given along the way and when people arrived. However, in reality, the rations were gone by the time many people arrived. Or they were bad meat or they were just inedible. And so, they caused not only people to move, but then once they arrived, caused many more deaths. Either along the way or once they were there. A lot of it was unfamiliar food that couldn't be cooked or digested. Food played a major role in the Trail of Tears and what happened both before and after that journey.

And the quality of the land for agriculture that they were forced to settle on was part of the picture too, wasn't it?

 Yes. Some of it was good and some of it was absolutely terrible. And people were given no choice about where they were going to end up.

Let's fast forward to more current times. The U. S. Department of Agriculture has created several very important nutrition programs with the stated aim of improving nutrition. But you've raised some concerns. Please tell us why?

Yes. If we just think about that journey that began with the Trail of Tears and with George Washington's order. And then the role that food rations have played in the relationship between the United States and Indigenous people. The rations that were first introduced in trying to force that move, then played a role in many elements of this policy. For example, rations were taken away if parents would not give up their children to the federal Indian boarding schools. They were taken away as a punishment if Indigenous people engage in their own cultural and kinship practices under the Code of Indian Offences.

And so, rations played a huge role, and they continue to do so. They have now transformed into what is the food distribution program for Indian reservations. Which is another system whereby the United States is providing food to Indigenous people who are living on reservations, do not have access to many food sources at all, and so, are in need of nutrition. But the contents of the food that are given out through this program don't reflect the needs of the people who are receiving it. They reflect the needs of the agricultural industries and the surpluses that the USDA is responsible for getting rid of because of federal subsidies through the Farm Bill.

You've written as well about food marketing. Tell us what your thoughts are on that?

Food marketing is so important because it really defines in our society who eats what. It tells us a story that is rife with racial stereotypes and kind of propaganda about food. And it also determines the food landscape in many ways. When I think about race and marketing, marketing first of food really just employed a lot of racist tropes. Because marketing was directed only to white people. And, you know, racism was something that sold. We've seen that change and become more subtle over the years to the present where we even see food marketing taking on anti-racism as a form of what's called woke washing, to try to gain consumer dollars by adopting a certain political position.

The issue of who is targeted by marketing is enormously interesting, complex, and highly important. I'm glad to see you addressing that in your book. Let me ask one final question before we wrap up. How is the U. S. Constitution involved in this?

I have a theory as a constitutional law professor that the way that the United States has dealt with food in a way that creates racially disparate outcomes violates both the 13th amendment and the 14th amendment. So, let me explain. The 13th Amendment says that anything that comes out of slavery as a vestige, or a badge or a marker of slavery is not allowed. And that means that policies that began back then, that continued today with discriminatory harm are prohibited under the13th Amendment. I talked a little bit about how during slavery food was used to oppress and subordinate. And that caused health problems. Very racially disparate health problems where enslaved people suffered from illnesses and conditions and deaths associated with food and malnutrition at much higher rates than white people. That was explained away by constitution and genetics, but that was all lies. In the present, we still have those disparities and they're still due to deliberate policies that create this oppression, the food oppression that I talked about in the beginning. The 13th amendment should not allow that kind of food discrimination in the same way that it doesn't allow housing discrimination. Now, under the 14th amendment, all people should be treated equally by the government. But what we have is food policy that treats people differently based on their race. In the case of the Food Distribution Program on Indian Reservations (FDPIR), that's quite clear. In some other cases, like public school lunches, you have to kind of take a step back to understand how there are racially disparate effects. But the same commodities that the USDA is responsible for getting rid of, that they do through the Indian reservation program are being sent to schools. And these are public schools where in many districts, there are many more Black, Latina, indigenous students than white students. For example, where I am in LA, that's 94 percent of the public-school population. And the government is using that program to get rid of very unhealthy food that is making kids who go to public schools sick. And that is unequal treatment under the law. It should violate the 14th Amendment.

You know, I'm not an expert on constitutional law, but this is the first time I've heard this argument made and it's really an interesting one. Do you think there would be a day when we would see legal action based on this theory?

I think it's possible. I don't think that legal action would be successful in our present moment of jurisprudence. But I think that framing is really important for people to think about and to understand what is happening. And I think that sometimes thinking about things as unconstitutional can provoke social action. Social movement. It can allow people to think about injustice in a certain way that creates resistance. So, I think it's important, even if we can't bring a case today, on that basis.

BIO

Andrea Freeman is a law professor at Southwestern Law School in Los Angeles. She is a national and international expert on the intersections between critical race theory and food policy, health, and consumer credit. She is the author of Ruin Their Crops on the Ground: The Politics of Food in the United States, from the Trail of Tears to School Lunch (Metropolitan 2024) and Skimmed: Breastfeeding, Race, and Injustice (Stanford University Press 2019), in addition to book chapters, law review articles, and op-eds. Skimmed is currently in development for a documentary with Topic Pictures. Her work has been featured in publications including the Washington Post, New Yorker, Los Angeles Times, Salon, Huffington Post, USA Today, The Root, Yahoo! News, The Atlantic, NPR Shots Blog, Pacific Standard, The Conversation, Medium, Atlanta Journal-Constitution, and National Library of Medicine, and she has done interviews with news outlets and programs including CBS News, PBS News Hour, The Takeaway, Here & Now, Point of Origin, Newstalk Irish National Radio, Heritage Radio Network, The Electorette, Hawaii Public Radio. She studied food inequality in the UK as the 2020-21 Fulbright King's College London U.S. Scholar. 

Empowering Women in AgriFood Tech: A Conversation with Amy Wu of From Farms to Incubators - In this episode of the Leading Voices in Food podcast, host Norbert Wilson speaks with Amy Wu, the creator and content director of From Farms to Incubators. Amy shares her inspiring journey in highlighting and supporting women, particularly women of color, in the agri-food tech industry. Learn about the origins of her groundbreaking documentary and book, her vision for a vibrant community of women innovators, and the crucial role of education, mentorship, and policy in advancing women's roles in this sector.

Interview Summary

I have a great set of questions for you. So, the first thing, could you just tell our listeners a little bit more about From Farms to Incubators?

Sure. From Farms to Incubators is a special initiative and project that tells the stories of women in this fast-growing field known as ag tech, sometimes interchangeably used as Agri food tech as well. The mission of it is really to get more women involved in ag tech through storytelling, through resources, and also through education and training. I also would describe it as a multimedia content platform. I actually came to this as a journalist and as a storyteller that uses storytelling to amplify the voices of women leaders and entrepreneurs in this field. It's also a documentary and a book and also a website where we archive their stories and their biographies as well.

Thanks for that overview, and you just talked about the book and the documentary From Farms to Incubators: women innovators revolutionizing how our food is grown, which uses storytelling to highlight women innovators and how women innovators in the Agri food tech are doing their best. But there's also a movement and the community and this multimedia platform. Why did you expand from the book and documentary into this larger network?

That's a really good question. Briefly, as some context, I kind of fell into this project. It was a bit of serendipity. I was a reporter in Salinas, California, which is the vegetable salad bowl of the world. Ag is a huge industry, a 10 billion industry. And I was covering government and agriculture. And I observed that there were not a lot of women at the helm of the table, whether it be at farms or also in this growing field of ag tech as well. So it started off as a documentary. I got a grant from the International Center for Journalists, and then ultimately I got another grant from the International Media Women's Foundation to do a short documentary to profile three women who are entrepreneurs in ag tech. It was great. It was at the time in 2016, which now was ages ago, I guess. It was really hard to find women in ag, in this field of ag tech, women creating the innovations to tackle some of the biggest challenges that farmers are facing, especially under climate change. So, it could have ended there because the documentary turned out to be very, very well received. It's screened at hundreds of places, and I would have panels and discussions and the women would look at each other like, 'my gosh, I didn't know there were other women doing this too. Can you connect us? We'd love to convene further.' And then educators, community leaders, agribusinesses, investors just didn't know they existed as well. So, what happened was the stories kind of multiplied and multiplied as the more that I collected them. And then I decided to put it into a book profiling about 30 women in this growing field.

And to answer your question, Norbert, why is it continuing is that I saw a real need for women to have a community, women in agriculture and innovation and food systems to have a community to connect with one another, to potentially build friendship, build collaboration, build partnership, creating a collective vision sometimes and a place for them. I didn't plan on it. So, I guess the storytelling connects them. We've also have resources like a database that connects them and the goal is really so that they can have a community where they can build more. They can either build out their own startups. They can build their careers, build their professions. And then it kind of grew more legs. Now we're also extending into the area of education and training to try to get younger women, young people, youth. To see that agriculture, hey, may not be traditionally sexy. I mean, tractors and overalls are still what a lot of people think about it, but there are so many other opportunities in the food system for young people as well, especially since we all have to eat. So, how are farmers going to be producing the food for 10 billion people in 2050, right? Who's going to produce the food? How are we going to do it? Especially under the auspices of climate change, the weather's getting crazier and crazier. That's sort of why it has expanded from the stories all the way to what it is today.

This is a great story and I would love to hear a little bit more about some of the women and their innovations. And if I may, I would like for you to actually even explain a little bit about what you mean by the ag food tech or Agri food tech as you're talking about these women.

Broadly defined, is any kind of innovation that makes it easier, frankly, for farmers to do their work, to grow more efficiently, and to also increase [00:06:00] their yield. I can give some examples of what innovation is. Blockchain addresses food safety, really. It traces everything from the seed to all the way on the shelf, right? So if there's any safety issues, it's used to trace back, where did that seed come from? Where was it grown? What field was it in? And that really helps everybody in the food systems a lot more, right? We have sensors connected with drones. I forgot to mention robotics as well, which is a fast-growing area of ag tech. Everything from self-driving tractors to laser scarecrows to another level of robots that are picking specific kinds of fruits and vegetables that's tackling labor challenges. I don't foresee that ag tech necessarily is a replacement by the way of people. It's actually offering more opportunities because we need people who are very knowledgeable that kind of innovation.

And then you also asked a bit about the stories of the women in ag tech, for example, in the film and in the book and so forth. Soil sampling is a fast-growing area of ag tech. There's the story that I have in the book and also in the movie of two young women who are Stanford PhD graduates. Who created a soil testing kit that makes it easy for farmers to just test their soil for diseases, for pests, and soil testing is traditionally, you know, very, very expensive for most farmers actually. Not easy for farmers to get access to it and to get the data, but the soil testing kit that they created makes it a lot easier for farmers, small farmers even, to access it. And why is that important is because the more knowledge, the more data that, and analytics that farmers can get, the more that they can make smart decisions about how much to fertilize, how much to irrigate.

And that connects with the yield and their success. You know, another company that I can think about, another amazing woman. I just like her story, the story of AgTools and the story of Martha Montoya, who was actually an award-winning cartoonist. And she doesn't come from agriculture at all, and that's actually something that I want to highlight is a lot of these women are not farmers and don't come from agriculture. But she was a award winning cartoonist. I believe she was also a librarian and she fell into the food industry, and saw a need for having more data, offering more data and analytics to farmers. She created a system a little bit like a Bloomberg for farmers, where they can get real time data immediately on their phones, on their watches, so that they can get second by second data to make decisions on specific crops.

Those are a couple of the stories that are in the book, but really what I want to highlight is that all of the innovation that they are creating addresses some of the biggest challenges that farmers are facing, whether it be labor issues,lack of water, some areas of our country are becoming more wet, others are becoming more dry, drones that are actually doing the irrigation now or drones taking photos to give more data to farmers as well on what is their land look like. You know, it could also be human resources related as well to manage staff. So mobile apps to manage staff on cattle farms. I mean, how big are the cattle farms sometimes, you know, 50,000 acres. So, it's really to save money and to create efficiency for farmers.

If farmers are able to do their work more efficiently, they're able to generate greater profits, but it also allows for food prices not to rise. This has really big implications. Thank you for sharing those stories. And I love hearing about some of the individuals, but here's the question. I mean, why focus on women? What's important about what women contribute to this? And also, why are you also considering race as an important lens in this sector?

Well, I would say, why not women? Because women have already been contributing to the global food system, whether in the production end or the decision makers at the head of the dinner table for thousands of thousands of years, arguably. So what I discovered is that their stories, their contributions, existing contributions were not being celebrated and were not being amplified. And I actually discovered that a lot of the women that I connected with were a bit shy about even telling their story and sharing it like kind of like, 'what is my contribution?' And I'm like, 'well, why aren't you sharing your story more?' So the goal of it really is to document and celebrate their contributions, but also to inspire. As I said, young women, next generation, all of us have daughters, nieces, granddaughters, you know, and then future generations to consider opportunities in a field where we need people. We need people who are smart and you don't have to be from a generation of farmers. You could be in science, engineering, technology, and math. You could just be passionate about it and you could be in the field. So that's the first aspect of it.

And in terms of the lens of gender and race, there are not enough women in terms of just the startups in ag tech right now, only 2 percent of the billions of dollars being invested in ag tech startups. Only 2 percent are going into women led companies. It is very, very little. It is a problem that is deep rooted. And it starts with [00:12:00] funding. One problem is where is the funding coming from. Venture capitalists, traditional avenues of funding, where it is traditionally male dominated. So, there are many studies that show that investors will invest in companies where they connect with those who are leading the companies, right? So similar gender, similar backgrounds, similar stories. So, we're really looking to have a paradigm shift and move the needle of sorts and say that if there are more investors, there are more board members who are from a diversity backgrounds, then there will be more funding for women and those who are traditionally not leading agriculture, not in the leadership positions, not in the decision-making roles, right? There is a problem. There is a, what is a grass ceiling, not just glass ceiling, but grass ceiling.

I hear you. I hear you. Now this is really fascinating. I know from colleagues who are in agriculture that there is this demand for more agricultural workers throughout the Agri food system. And if there is a demand, we're saying that our colleges that produce the potential workers aren't meeting those demands. One of the ways we can see that change is by having more women and more people of color join in. And so, this is a critical thing. And I would imagine also the experiences that people bring may be a critical part of coming up with new innovations. Diversity can do that. This is exciting that you're exploring this.

I love what you're saying Norbert. I know I wanted to touch upon that about what you just noted is that it's also to create a pipeline, right? Education training is just so critical. And it makes me so happy to see that there are more and more programs at universities and colleges that are addressing programs in food systems, in agriculture, and increasingly in ag tech. So, whether it be courses or programs or certificates or eventually minors and majors, developing the pipeline of talent is really important and having mentors and mentees, which is something that now we're working on. This fall we'll have launched a menteeship program for women and for young people interested in ag tech and the first collaborator is the UC Merced in California. So, thanks for bringing that up. We have a couple of young people ready at the starting gates. Really excited.

I will say just on a personal note, I was active in 4 H for most of my youth and that's the way I got involved in agriculture. So, touching or reaching out to folks in their youth is critical to get them excited and help them to make the connection so that they can do that work further. I'm glad to hear this work. In your view, what are some of the ongoing challenges and opportunities that women face in the ag tech sector or the Agri food sector? What are some of the things you're observing?

Well, a continued challenge is having a place at the table, meaning at the leadership and decision-making level. And actually, as I noted earlier, the access to funding and not just the money, but the access to resources, meaning could be legal operational. Just how to get their startups or get their ideas out there. One example that I'm seeing that's again positive is that there's a growing number of incubators and accelerators specifically in food tech or ag tech that are is actually looking for candidates who are women or who are from underrepresented communities. The first thing is that they have a great innovation, of course, but the next thing that the incubators and accelerators are looking for is to have a diversity of perspectives. And to have representation, so seeing a lot more of that, whether it be. Individual accelerators, or even once at the university, right? Universities and colleges and the governmental level.

The other challenge is access to farmers and connecting them with the farmers themselves. Cause farmers are very, very busy and that's highlighted and bolded. Increasingly just dealing with this chess game that's very hard to play with the weather, but also with their own resources. It's expensive being a farmer, equipment, labor. They don't often have the time, frankly, to beta test some of the innovations coming out. So how best to connect innovators with the farmers and to have them communicate with each other: like this is the innovation. This is how it's going to help your problem. Educating the farmers and allowing them to see that this is how it's going to address the problem that I have. So, the two are still kind of separate and access to each other is still, I would say, a major challenge. But right now, some of the solutions are, as I've noted, networking at conferences and convenings. Also, under the grant programs sometimes under the National Science Foundation or USDA, they are allowing more collaborative initiatives where you have educators, where you have policy, where you have the innovators, where you have the young people. Increasingly, seeing more and more of those kinds of projects and initiatives happen. So hopefully everybody will have a seat at the table and that would help women out a lot in the field as well.

Awesome. Thank you for sharing those. And I love the fact that you're looking at not just identifying issues, but also trying to find ways of connecting folks to help overcome those challenges that women and women of color are facing in the marketplace. And it's the connections that are really critical. I appreciate you highlighting that. So, what is your ideal vision?

Oh, one more thing I forgot to note is that in terms of connecting, there's also a database - a women in Agri food tech database, and I, and at least four or five other women in the field have been working on for at least four or five years now. We now have more than a thousand members. It's an open-source database where you can click on a form, put your name there and information takes a few minutes and then you're added to this database where the women can be connected to each other as well. So that's another resource.

Yeah. And I mean, even just having peer mentors, not just mentors who are above you and they've like solved all the problems, but having people to go along with you as you're developing and as they are developing can be a critical part. I know as an academic, that's important for me and has been important for me. And I can imagine the same is true in this space as well. So, I'm so grateful to hear about this work. Yeah. What is your ideal vision for women in Agri food tech in the next, say, five years? And how will the digital network for from farms to incubators play a role in achieving that goal or those goals?

So, my dream - it always starts, I think, in the dreaming phase and then connecting that with also resources along the way. But if I could wave my magic wand, I would say that. We would have a lot more women in leadership and thought decision making positions in ag tech to the point where maybe we won't even need something like From Farms to Incubators anymore because they'll be already equal. The stories will be out there. So, it might be questionable as to why we have a special subgroup or network for this now. How to get to that vision, I think is the three components of increasingly having more stories, and the women tell their stories at public outreach. You know, it could be at conferences, it could be in their own communities, sharing their story out to the community of farmers, of local government, of schools, local schools and colleges and universities, gardening clubs.

The second component is education and training, building a pipeline. A vision that I have is actually having a campus. A virtual, and also in-person campus where women, especially from women in underprivileged communities will have the opportunity to have training and to be connected with mentors and the rock stars in the ag tech and Agri food tech field. Where they will also be able to have a project and initiative and test it out and have something to add to their portfolio. To have classes and people who are teaching those courses as well, ultimately. And then also to just build up a hub of resources. Like I mentioned the database. I mentioned that we'd like to extend it to having resources where folks can easily access internships, fellowships, granteeships, where they can be connected to funding. If they need help with legal, HR, just all components of everything that's needed to have a successful organization.

And it doesn't have to just be their own startup. It could be a job database of where we have larger organizations and companies that are building up their own ag innovation or food innovation center as well. So that is the vision. It's a big vision. It's a big dream. So we're going to have to kind of break it down into components. But I think taking it step by step is the way to go kind of like climbing Everest or doing a long distance swim.

Yes, I can see where you're trying to go in this vision and I'm interested to know what, if any role policy could play and help advance that vision.

Yeah, so what role could policy play in advancing this vision? Currently, when it comes to diversity inclusion in the ag tech field or even in agriculture, there is somewhat a lack of policy in a way. But then also with individual organizations and corporations, obviously, there is the movement of diversity inclusion. But also, I think it's very much with the hiring practices with HR. I think it's up to individual organizations, whether they be small, larger ones, governmental, to look at their own hiring practices. To look at who they are, how are they crafting the language when they look for a job, when they look at their leadership team, are there ways to further diversify it and when it comes to, gender, ethnicities, people who come from a rural area, urban. I mean, we all come with, from a diversity of perspectives and stories. I think a lot of it will come down to hiring practices and advancing this vision and with the individuals who are already working at those organizations to be more thoughtful and conscious about giving those who don't have a place at the table, a place and a voice at the table, giving everybody a chance. Because we have some amazingly talented and knowledgeable people who just traditionally in agriculture don't have families and generations who come from an ag background. But they do come with so much that they could offer. I would say that those are a couple of examples of that as well. And maybe, more discussion about policy is really needed on a larger level when it comes to farmers, when it comes to government leaders, when it comes to innovation leaders as well. And when it comes to educators and schools. I think the more the merrier when it comes to bringing folks at the table to open it up for discussion on solutions.

I appreciate this. And, this idea of not just welcoming people so that they get in the door, but also creating change. Environments and spaces where people are actually welcomed once they're there. That it becomes a place where folks can be themselves and bring all of who they are to the work that they're doing. This is critical.

Yes, absolutely. I want to touch upon that. My own story is I don't have an agricultural background myself. But when I first , landed in a place like Salinas, very much sort of an outsider because I'm not from there anyway, but also not in agriculture and then being a woman and being, you know, a Chinese American woman too, you know, I, I did feel that there was a challenge to kind of break into certain circles and to be welcome. Even despite my passion and enthusiasm, there was a little bit like, 'what is she? Why? Why? What? She, she doesn't know anything.' But I felt like it was the people who in the beginning, it was just a couple of people who were like, 'Hey, this is somebody who really wants to tell the story of what we're doing. Give her a chance.' You know, having advocates, frontline advocates made a huge difference. So that's what I'm hoping for, more frontline advocates.

Amy, I want to pick up on a personal story out of this. I did my graduate training out at UC Davis, at University of California, Davis. And I worked on dairy policy, which I do not have a dairy background. And it was great to have a mentor who actually helped me. Who introduced me to a number of folks and working through extension and the California Department of Food and Ag. Folks made space for me, and they understood that I was interested in this particular policy and trying to understand what it meant. And I actually got to learn so much. It was because people just said, okay, we'll give you a try. And I did the best I could. I'm grateful for that. Creating these spaces is not hard. It's not impossible. It can be done. I'm really appreciative of your efforts to keep furthering that story.

I love that story. And indeed Norbert it's like what you said, creating the space and even, even in the beginning and just having a couple of folks just to make space. And then I think the space is going to grow from there.

I fully agree. I've got one last question for you. And it's, sort of related to the vision, but just also thinking long term. What impact do you hope your work will ultimately have on society.

I hope that my work will create a bit of a shift ultimately. I mean, that's a rather large goal, but it's not just myself. As this project has grown and extended and expanded. It's really a joint team effort. I mean, along this journey, I've met folks who are mission aligned. And they also see the value in this, and they believe in something similar. Whether it be that they contribute their story, whether it be that they help write the stories, whether it be that they come be a guest speaker, and they share their career, and then they end up connecting with the younger person, every person counts in this. In making a shift. And it might take generations to completely have a paradigm shift, but I think that just moving the needle a bit is ultimately the goal, certainly. And in terms of the bigger picture of things, I'm hoping that it will continue to spark a discussion and ongoing conversation about the importance and the value of bringing different voices and people who traditionally were not given a space at the table when it comes to the food systems and agriculture. But who brings so much talent, so much to the table already. How we can make greater space for them as well, and how we can incorporate their talent and create a better food system for everybody. We all eat and we're looking at 10 billion people in 2050. So, looking at the people who are making those contributions and telling their stories and especially for those who traditionally have not had their voices told, I think is really, really important. I just keep the fire going, I guess.

BIO

Amy Wu is an award-winning writer for the women’s Ag and Agtech movement. She is the creator and chief content director of From Farms to Incubators, a multimedia platform that uses documentary, video, photography, and the written word to tell the stories of women leaders and innovators in Agtech. It has a mission of highlighting women in food, farming, and farmtech, especially women of color. From Farms to Incubators includes a documentary and a book that spotlights women leaders in Ag and Agtech. The documentary and stories have been screened and presented at SXSW and Techonomy. The initiative was awarded grants from the International Center for Journalists and International Women's Media Foundation's Howard G. Buffett Fund. Amy was named on Worth magazine’s “Groundbreakers 2020 list of 50 Women Changing the World” list. Since 2018 she has served as the communications manager at the Hudson Valley Farm Hub in Hurley NY where she runs the website, digital newsletter, and social media. Prior to starting From Farms to Incubators, Amy spent over two decades as an investigative reporter at media outlets including the USA Today Network where she reported on agriculture and Agtech for The Salinas Californian. She’s also worked at Time magazine, The Deal and contributed to The New York Times, The Huffington Post and The Wall Street Journal. She earned her bachelor’s degree in history from New York University, and master’s degree in journalism from Columbia University.

In today's discussion, we will explore the application of debt relief to large investments in environmental sustainability, which can also support local development, including more resilient food systems. This is particularly timely, given the juxtaposition of enormous debt burdens with increasing environmental commitments by developing countries. Debt for relief swaps, such as financial forgiveness for cash strapped countries if they invest those funds to support global environmental goods, have been around since the 1980s. However, they haven't achieved their full economic or environmental potential, says Duke University Economic and Environmental Policy Professor Alex Pfaff. Smart reforms to improve debt relief programs can allow nations to help themselves and fulfill commitments to preserve the planet. Pfaff and colleagues described needed reforms in a recent analysis in a policy forum for the journal Science, also summarized in Foreign Policy magazine. His co-authors are sustainability expert Elizabeth Losos and conservation professor Stuart Pimm from Duke University. They note that global society has now learned lessons, not only from past debt for nature swaps, but also decades of evaluation of climate change of environmental and development policies.

Interview Summary

I have to say, having read particularly the Science piece, it is clear and it's very straightforward and accessible. But the other thing, it's hopeful. And I think in this moment of climate concerns, it's great to know that there's some ways to possibly move forward. I'd love to hear some more about this. If you don't mind, would you just describe a debt for nature swap? I gave a little bit, but I'd love to hear your consideration of it.

What you said is right. And I'll just agree with you first that we're definitely in a time when doing the right things could help a lot. One of my motivations is a little bit of fear in there, which is, if we don't take the opportunity we look back later and regret it. Which is one of the reasons why we're out there trying to bother people to do what we think would be more effective.

So, coming to the definition. A debt for nature swap, as you said is like it sounds. It's an agreement to forgive debt that countries owe on one condition - that they invest part of that money in some form of investment in nature. It's often been conservation. That was often thought of in terms of species or biodiversity at the time. But nowadays that would include thinking about storing carbon because of climate concerns, and then linking to your use of the term resilience in agriculture - for sure this also could be thinking about a climate adaptation.

Can you give us some examples of countries that have done this? What does this look like on the ground?

Yes, and the history, as you say, is that it started in the 1980s. And we really want to tip our cap to Tom Lovejoy who invented this at a time when, again, as you laid out, but it, at that time, was also true. There was huge amounts of debt and huge concerns about conservation, and it was a pretty simple idea. That it is a potential source of money to invest where the countries can help themselves, as you said, by getting rid of really quite crippling debt - tremendous amounts of interest are being paid on those debts - but also be helping the globe by investing in nature. So countries recently done, for instance, Ecuador has done a very big one recently. Belize has done one that's quite well spoken of. Those are different sized countries, different sized problems, which, as you can imagine from your own work, the institutions matter a lot. But there's been a long string and a long history of willingness to try. And I guess the last thing is that willingness started to go down when, as you summarized, it wasn't really working for the debtors who weren't really getting that much relief in their point of view for a lot of time bargaining. And it wasn't really working perhaps for nature. It wasn't having necessarily the impacts that one might have hoped. So, I think the question now is can we reform them? Because we do still have a big debt problem and we have some big nature problems.

Thank you for sharing that. And it's really fascinating to know that this is not a new idea. It's been around since the 80s. And this hope that I mentioned earlier suggests that there can be ways to make this debt for nature swap work better. I would love to understand what you want readers to take away from the reforms that you all suggest in the article.

Yes, and the punch line at the high level is it makes sense. It hasn't worked as done to first order. Of course, some things have worked. But simple reforms based on things that we have learned over the last few decades could make them work a lot better. So that's the high level. To get a little more detail the four things we say in those articles are the following. You gotta raise the scale. It has to be consequential relative to the scale of debt. Otherwise, it's not worth it for those countries. I think, and we think, and I'll give you the third condition in a moment, but I think for those countries also you have to emphasize local choice and sovereignty. Because there's a real sense of, geez, why are these conservation NGOs coming in telling us what to do in our country? I think there's clear gains to be had from letting local actors decide how to achieve global goals.

Now, the next thing you say is why if they are choosing, well how are they going to be oriented towards achieving global goals? So that's our third condition. You actually have clear measures of outcomes, and you only give relief conditional on measured improvements. That's a huge difference. That really has been more of a process bargain in the past. You will allocate some money to protected areas. Okay, that's fine, but there's actually a very famous fund which allocated money to Brazil. People have shown that Brazil just pulled the money out and spent it on other things that they were spending and just replaced it with the external money. So, then funding [for nature conservation] didn't go up. Or you could say, draw many new protected area circles on a map. Okay, but drawing things on a map doesn't really necessarily get you anything at all. And even defending a place that wasn't going to disappear doesn't get you anything because it wasn't going to disappear. So, there are many stories that in evaluations like I do of environment and development policy, we’ve seen a lot of things that sound sensible but don't really do that much in the end. Great, fine, here's a nice combination. We're going to measure the outcomes. But then you can do whatever you want, right? You can do whatever you want. If for you, you want to expand energy access, but you want to invest in renewable energy, great. A different country wants to stop using agriculture in a particular area and move it to another area, right? Another country wants to intensify agriculture and raise productivity even while leaving space for forests, and the knowledge, the preferences and the right to choose that I think and we think are naturally left with the countries in question who 1) has more information, and 2) are probably the right source of priorities for what matters locally, and if they don't find it interesting. These deals aren't going to happen again. You might then say, why are we just doing what they want? Because you're only giving relief when you measure actual global goals. Once you do that, once you switch to measuring outcomes, you should let people choose what's sensible for them.

Last thing, once you're measuring, as I've mentioned, there's a bunch of different goals you could imagine, right? If I get two NGOs, they don't even have the same goals for species. Forget climate change, forget climate adaptation. There are all these things that people would like to be helpful with. So take, for instance, a project that might save old forests. That probably helps with water quality downstream. It probably provides habitat for species, it definitely stores carbon, and when blocking rainfall that comes torrentially with climate change, it probably helps resilience and washing out of soil for agriculture. What's our last point? When you're counting outcomes, add together all the good ones, because then a project like forest gets points for all four of those. And you do this stuff that's efficient on multiple fronts instead of going left hand, right hand in an uncoordinated fashion. So those are our four suggestions.

That's really helpful. And having spent time with international trade and issues on regulations, one of the things that I've learned is permitting or allowing sovereignty and allowing nations to make decisions, one is politically important, but on the sort of economic side of it, there is something critical about countries knowing their own costs and own, if you will, demands. And allowing them to make those determinations is critical for an efficient and actually politically feasible approach. Is that a fair assessment?

I agree completely. You know agriculture much better than I do. But that description to me fits perfectly. You can come in and say you've got all sorts of good ideas. And even things that are good ideas won't go across because you came in and said them in an annoying way. And then, as you said, [local] folks have better information on what their costs are, better information on local benefits, they could probably design a locally incentive compatible version of what you thought you knew was good. It might have been kind of good but with the local information and interest, it becomes better and then thus more likely to happen. And that's better for the globe as well. I completely agree.

This is great. You've mentioned agriculture a couple of times, and I'd like to hear a little bit more about how you think debt for nature swaps can affect the food and agricultural systems in a country. Especially given the agricultural practices have some significant impacts on the environment and or can be affected by the environment, and particularly climate change.

Completely. Yes, I think it's because of that. Exactly. So, if I had to think of why this environmental resource paper is a fit in agriculture, it's because of what you said. That agriculture bumps up against the environment, so to speak, makes use of nutrients in the soil, sometimes involves the clearing of the land, and bumps up against the public. As climate changes, it really changes the ability to do agriculture in terms of temperature, rainfall, all those things. So, I think just for instance, if we go across all the World Bank labeled low-income countries of the world, the priority on climate adaptation under rainfall shifts versus climate expansion into forests, which could be replaced by climate intensification through more fertilizing and more pesticide use, so that agriculture takes less room but has higher yield. Those priorities are going to vary massively. I think agriculture is a fantastic sector, and it's not been a surprise that you said the things you did to think about the value of measuring the global goal and allowing the local choice.

In some places over fertilization is a huge problem. Not only do you not get more productivity, but you waste money, and you ruin water supply. Some places, pesticide use is an issue and is drifting across and killing plants and other fields. Some places, it's not. And who's the expert on that? Probably the local agricultural extension agents, right? And the local ag agency. So, to me, agriculture is a fantastic, illustrative sector. Not the only one, but an important one. Where the kind of things you said about the value of local information and choice come through in making a big financial swap like this potentially work for everybody.

Thanks for this example. It is great to hear this piece that did have a clear environmental focus, recognize that there is a place for the food system to be a part of that conversation. So, thank you for sharing that. You know, the debt for nature swap is a useful financial tool to support environmental causes, as I just said. And as an environmental economist, how do you use a market-based approach to address environmental challenges? And what, if any, drawbacks do you see to this approach?

In a way this is a form of market-based approach. I agree with you. It's certainly about prices and incentives. And looking around the world, I'm not sure if this is why I'm an economist, but I certainly do think people respond to incentives and that's important. That said and you said drawback. First, I'll just go with alternative to start. Prices are not the only thing people respond to, right? Institutions matter a huge deal. Even the set of opportunities that are available tend to be constructed in ways that are not price or market driven. You know, prices are wonderful. If you have a hundred identical firms and you're trying to figure out who has the lowest marginal cost of reducing carbon emissions. Fab, let them figure it out. Market will do well. Maybe not as fabulous in thinking about the distribution of rights locally between indigenous groups, small farmers, and large multinational corporations, right? Maybe that's not really a market price thing. And we might even get around to values. There are times when people don't really want to operate in a price space. And they're going to have to deal with incentives. But think about preexisting values on conservation, and when those are achieving the same goals as a price would, you don't have to try to wander in with a new market. I think that's fair as well.

I think of incentives as one super important tool. Far from the only one and somewhat in the spirit of our discussion of local knowledge. The right tool blend is an important part of the story as well.

Alex, I have to say, you've ventured in some spaces I'm really happy to hear you talk about. This idea of incorporating values and recognizing that the local knowledge matters - this is not something that we, as economists in our modeling world alone can solve the problem. It is going to take talking to people and learning their needs and learning even the bits about their culture to say what works for them in this moment. So, thank you for sharing that.

You're welcome for that.

In your analysis, in the team's analysis, you all argue for key reforms for debt for nature swaps. What other approaches would you consider to address these large environmental concerns?

I think ‘other’ but also complimentary. I'm in the sense that these are very high-level transfers, right? Here's a bunch of money. Please do something right. And as I said earlier, if we tell them what to do, we don't have a great track record. So, now we're going to maybe measure, right? One of our suggestions is to measure the outcomes. How are they going to get to those outcomes, right? So, there's a whole bunch of tools on the environment and the development policy side, which are also part of the source of learning over the last three or four decades. There's been a real push in a lot of fields, not necessarily to only be like medicine and do randomized control trials, etc., but there is some of that. But also just collect some data on what happened. Please try to figure out if when you do a policy, it actually achieves something.

Besides values, my meta story these days is we have to allow that learning is a good thing. There's a lot of people who seem to not want to even want to ask whether what they did worked because somehow, it's embarrassing. And I feel like we have to move as a world to the humility of learning by doing. And that's just what everybody does. And that means when I did something, half of them worked and half of them didn't. It's a really good idea to learn as fast as you can which ones didn't. So that's a super general speech, not quite to what you asked, but it applies to every tool I've ever known.

So, regarding protected areas - do they always have impact? No. I have a lot of work on that. Can we start to, over 30 years point, to where they have impact? Yes. Could we have measured outcomes? We could have, but we didn't back then. So, could we still use traditional tools like use a protected area, but look at past studies of when they had impact and start to see that it makes sense when they did and when they didn't? Yes. Same thing for payments for ecosystem services and any number of other tools.

BIO

Alexander Pfaff is a Professor of Public Policy, Economics and the Environment at Duke University. He studies how economic development interacts with natural resources and the environment. His focus is designing environment and development policies to support choices by individuals and groups that protect nature, reduce damaging environmental exposures, and improve livelihoods.

We've recorded a series of podcasts on the microbiome and its wide ranging impacts. But boy is this a field that moves rapidly. As soon as you think you've covered much of the territory, along comes some new and exciting findings, and this is the case today. We're going to describe research done by our guest, Dr. Ibrahim Javed. He has done innovative work on links between the gut microbiome and the brain, particularly focused on Alzheimer's disease. Dr. Javed is an Enterprise Fellow and National Health and Medicine Research Council Emerging Leadership Fellow in Clinical and Health Sciences at the University of South Australia.

Interview Transcript

So let's begin, if you wouldn't mind, with an explanation from you about what the gut brain axis is and tell us how it's important.

Yep. Now we see a lot of, a lot of researchers around the globe building on investigations around the gut brain axis. But if we, if we investigate what this gut brain axis actually is, It's kind of like a bi-directional communication between two organs in our body, the gut and the brain. And when we particularly talk about gut, we have our stomach and our different portions of the intestine.

What we're actually interested in is the microbiome and all those small little things living inside the gut. There are around 100 trillion microbes in the gut, which is three times more than the number of cells in our body. So, we are kind of like more microbes than, than human cells. And they communicate with different organs in our body and how they communicate with the brain that we can describe it as a, as a gut brain axis. And then this whole gut brain axis thing was somehow kind of invisible to us. We were just looking at it as a fecal material or waste coming out of our body. But now we see a lot of importance to these gut microbes. They help us in a lot of daily things that we do. They shape our behavior, our response to stress, our immune system, and then how we respond to different medicines, and how we do our daily tasks. So, they have a lot of roles in that. They help us digest food, that's their main obvious function. But now we are more. getting more and more information about them, that how they are integrated with a lot of different things in our body. So, kind of like they are partners in our life.

That's a very, very nice explanation. Can you tell us about the importance of microbial diversity?

Yep. So microbial diversity, we can, we can refer to, to as a composition of all those bacteria, viruses, and fungi to some extent that, that live in, in our body. Digestive track and, and in a lot of other animals as well. And this diversity is very crucial in maintaining the gut health and on overall well-being of, of humans. And, and this microbiome whole thing is like, it is obviously associated with a lot of health benefits and, and how we develop disease, but it's also right from the beginning of life they help us in developing our brains. They help us mature the brain system and the immune system. Obviously, they help us in digesting food.

So, generally, we can actually divide them in two portions. One, we can call them a good gut bacterium. They help us with all these things. And then they are bad gut bacteria, which are kind of like kept within a within a bay. They are kept under control by this good gut bacteria with the help of the rest of our body. And in somehow in some conditions with the age or with the dietary habits or environmental factor or lifestyle, if they overcome and, and they take over the control in the gut, that's where the thing starts going haywire.

When I was growing up, microbes were a bad thing. You didn't want to have microbes. And now, now we hear that there are good microbes and now you're talking about the balance. There are still bad ones, but good ones. And the balance of those two was a really important thing. Let's talk about how bad bacteria find their way to the brain. How do they get access?

So, as we discussed, they are kept within the bay or kept under control by good bacteria and also by other different immune systems in the body. We have different checkpoints, like we have different barriers or three different compartments, the gut and the blood and the brain. And we have barriers that separate out these compartments and these barriers are very tightly controlled, very good health cells tightly integrated with each other and they police that whole things what need to go across and what does not need to go across what we need to stop it within that compartment. If we have adverse environmental factors, or poor dietary habits and these bad gut bacteria overcome, they produce a lot of different molecules to communicate with each other. And they produce a lot of different molecules to take over the good bacteria. And these molecules, they can get across those barriers, and specifically if they can get into the brain (that's what we are researching), they can do a lot of different bad things in the brain. They can do that by hijacking this gut brain axis. And this compartmental thing is one pathway that they can get from gut to the blood and then from the blood to the brain. But there is also a direct highway that connects gut to the brain and that's our enteric nervous system. These are specific nerves or neurons, for example, vagus nerve, they're quite famous. It's a direct link between the gut and brain. This nerve system helps us in a lot of different daily tasks without us even knowing about it, like digestion and heart rate and respiration, and emptying the stomach. And these are kind of like a pathway for bidirectional communication. So, a lot of molecules go up and down across these highways and the bad gut bacteria can actually hijack it and they can put their stuff into this highway and they can send it across the brain.

It's a very, very nice explanation you have of a very complicated process, and I find it absolutely fascinating. So, you've spoken about how bad bacteria can be opportunistic pathogens and can trigger problems or enhance the progression of existing problems. How does all that work?

So, we are investigating bad gut bacteria in connection with dementia and Alzheimer disease. We are specifically working on Pseudomonas aeruginosa and E. coli and they are quite common, like a lot of school kids. They know about these bacteria. They are quite commonly studied in high school microbiology.

So, these bacteria produce some molecules which help to make biofilms around them. They kind of build a castle around them to protect their colonies and for their own survival and they keep surviving then until they get an opportunity to expand their castles and build more biofilms. These molecules are quite similar in terms of their structure and in terms of how they communicate. With some proteins which are not related to bacteria anyhow, they are produced in the brain to do some normal stuff in the brain, but they also aggregate in Alzheimer disease using the same mechanism as the nature that these bacteria use for these proteins to make their biofilms.

Based on this common similarity, if they can somehow see each other, or if those gut bacteria can send those proteins or aggregate of those proteins across the brain through using those highways. They can induce the aggregation of those normal, naive, working, innocent proteins, which we have in our brain that have nothing to do with the bacteria. But if they can be accessed by those bacterial proteins, they go haywire and, and they trigger the onset of the disease, or if there is already going on, that they can actually accelerate that whole process. And this is a concept, actually, we have seen that concept before in prion disease, whereby eating infected food that have those prion particles, they can actually go from gut to the brain, and they can induce the normal prion protein in the brain to start making aggregates in a similar way.

Are there interventions that can stop the pathogenic bacteria from in the gut that might in turn affect the brain?

We should focus more on preventive measures. We can focus on maintaining a good diversity within the gut of having or supporting those good bacteria in that fight and keeping them healthy and alive as we age. Because as we age over the period of life, we keep losing those good bacteria. If we can have all those good things of exercise, balanced sleep, and more importantly, good food and a balanced variety of food. Then we have a lot of different varieties to support that variety of gut bacteria in the gut.

So that's, I think, the most important preventive measure to keep that balance intact. But of course, in the future as a therapeutic intervention, we are moving towards developing microbiome therapies where we can modulate those compositions. If that composition is not in a very good situation, we can actually modulate that by using probiotics and prebiotic dietary factors or some microbial compositions like yogurt and a lot of other foods. We can modulate that to inoculate those bacteria which are missing in the gut and, and try to achieve that balance and, and that balance will accelerate the effectiveness of the medicine which we are taking for any other disease.

The advice we've heard from some of our other guests is to eat a diet rich in fruits and vegetables. You know, consume things, you mentioned yogurt, kefir, kombucha, sauerkraut, and things like that. Sound like they're very good for enhancing the health of the microbiome. Is there anything else beyond that that might be relevant for the brain in particular?

For brain health, there are some antioxidant foods. For example, we have Curcumin, and some senolytic compounds. We cannot call them drugs because they are kind of like a food supplements. They are available in any pharmacy and super stores by a lot of different names. Mostly these are polyphenolic compounds. They are usually available in green tea and in green tea extracts. They are quite well known for their healthy and antioxidant and anti-inflammatory effects. Research around the globe has shown that there are good effects directly on the brain by these polyphenolic compounds. So, these are green tea extracts, quercetin and, and some other galectin compounds.

BIO

Dr Ibrahim Javed is currently an Enterprise Fellow (Senior Lecturer) and NHMRC Emerging Leadership Fellow at the Clinical and Health Sciences, University of South Australia. He is also an adjunct Senior Research Fellow at the Australian Institute for Bioengineering and Nanotechnology (AIBN), The University of Queensland. He completed his doctoral studies at the Monash Institute of Pharmaceutical Sciences in 2020 and postdoctoral research at AIBN, The University of Queensland. He joined the University of South Australia in 2023 where he is now directing the laboratory of Gut-Brain Axis, Aging and Therapeutics. Research in Javed’s lab focuses on the gut-brain axis and its implications for aging and Dementia. His research team is working to unfold the specific role of bad/pathogenic gut bacteria in the aging paradigms and Dementia associated with Alzheimer’s and Parkinson’s diseases. His team has discovered and published the molecular details of how bad bacteria in the gut can trigger a younger onset (aged under 65) and accelerate Dementia and how the brain can develop Dementia when fighting with microbial biofilms in the gut – the infectious etiology of Dementia. With this research trajectory, his vision is to develop a multifaceted therapeutic intervention for aging-associated diseases and Dementia. 

Food companies market their products in a great many ways. Connecting their brands and products to sports and major sporting events is one such way and is drawing a lot of attention now. The reason is that the Summer Olympics are underway, which trains attention on the relationship between the International Olympic Committee and its longest running sponsor. Coca Cola has been a sponsor of every Olympics since 1928. So, it's intuitively obvious why sponsorships would be important to the Olympics because They get lots of money in the door and it's reliable.

It's been happening since 1928. But let's talk about why this relationship is so important to companies, Coca Cola in particular, and what the public health impact of that might be. Today's guest, Dr. Marie Bragg, has contributed some of the key studies on this topic. She is Assistant professor at the NYU Grossman School of Medicine, where she also serves as director of diversity initiatives. She holds an affiliate faculty appointment in the marketing department at the NYU Stern School of business; directs the NYU food environment and policy research coalition; and she's also a Food Leaders Fellow at the Aspen Institute.

Interview Summary

It's really nice to talk to you about this because it's an important issue and not a lot of science has been done on this over the years and you've contributed a lot of it. Let's talk about the issue of sports marketing and can you tell us a little bit more about what that is broadly and what's, what are some of the forms it takes?

You just mentioned one of the main areas of sports marketing with sports sponsorships. And so that's where a company like Coca Cola partners with an organization like the Olympics. And really is paying for the rights to have that famous Coca Cola logo or its products to appear at sporting events or in commercials that are involving the Olympics.

In terms of how much of it there is we know, for example, the world cup is one of the most watched sporting events in the world, along with things like the Olympics. The world cup, for example, has 5 million viewers. And so that's a lot of exposure for these brands, but it's not Sports sponsorship partnerships like that, there's athlete endorsements, and those dates back as far as to 1934, as one example, when baseball player Lou Gehrig first appeared on the box of Wheaties cereals.

There's a special place that athletes have always had in our society, and I think it comes through with these sorts of partnerships. But if we fast forward to today, our lab has even seen these kinds of partnerships appear in video games. And so, Nintendo had M&M's a race car game a few years back, and NFL Madden, which is a popular video game even has things like the Snickers player of the game appear within the video game, just like real NFL games. What this means is that these pictures of brands and products are peppered throughout kids experiences when they're playing video games. And then finally, if, and probably for anyone who's, been in a supermarket, when there's a major sporting event going on, like the Super Bowl or March Madness, it appears on products too in supermarkets.

It's peppered throughout our everyday experience in ways we might not always see or appreciate if we're not paying attention.

Marie, I like to do sports trivia with some friends of mine, and you've just given me a great question about Lou Gehrig and the Wheaties box in the 1930s. So that's a nice benefit of this podcast. So aside from that, why sports? I mean, companies could attach themselves to lots of different things, but why did they choose sports and why is that such a valuable connection for them?

One factor ties back into what we were saying about visibility. If there are millions of people watching a sport event, it means that there's a lot of time for brands to be able to have high visibility for whatever they're endorsing or sponsoring in that moment. On another level, I think on a deeper level, our society has a special relationship with sports and professional athletes.

Professional athletes are their own sort of unique category of celebrities that people love to follow and admire. That means that when a brand associates themselves with a sports organization like the Olympics or a professional athlete, they're buying into a special idea of what it means to be cool, to be fun, and to feel good about to feel good about the brand because when people are watching sports, they're excited.

If we think of other categories of life where there are maybe a high number of viewers to a specific televised event, like a presidential debate, that we don't see a lot of sponsorships around that. And maybe it doesn't evoke the same feelings that a sporting event does.

I'm expecting that this kind of relationship or attachments or symbolism of the sponsorship of sports might be especially powerful for children. I know if you ask kids what they want to be when they grow up, a lot of them will say they want to be a baseball player or basketball player, football player, something like that. Does that make sense?

I remember reading an article once that said, a dad was playing catch with his kid, and had spent all these hours with his kid working on pitching. And the dad made the point in the article, my kid doesn't want to grow up and be me as a baseball player. He wants to grow up and be ARod.

And so, this idea that we can spend all the time that we want with our kids and they still hold these celebrity athletes on such a pedestal is something that I think ties into why this is valuable for companies. It's kids who are engaged in sports or attending sporting events who are the next generation of consumers for these products. If they can get the attention and the brand loyalty of these children early on in these positive, exciting environments, it helps them secure the next generation of purchasers.

We'll talk about how important brand loyalty is in a minute, but let's talk about how valuable these connections are to the company. I guess one indication of that is how much a company like Coca Cola is willing to pay to be a sponsor of something like the Olympics. What kind of numbers do you know about in that context?

The companies don't usually disclose the exact numbers, but in 2008, NPR published an article that estimated that Coca Cola spent about 70 million to sponsor the Beijing Olympics. If we think about it, that's stunning given sponsoring an event is just one part of their massive advertising machine. More recently the Wall Street Journal estimated that Coca-Cola and a really large dairy company in China partnered and spent a combined, estimated $2 billion with a B, $2 billion for a 12-year Olympic sponsorship deal that will run through 2032. It's really incredible to think about that as just one slice of what they're doing, but with such a massive amount of money attached to it.

It really sort of begs the question what they are get out of it and what do they see as the value. I know there are branding opportunities, and again, we'll come back to that in a minute, but there's also sort of this goodwill part of it, isn't there. The Olympics are a great thing. No reason to question that. The fact that a company like Coca Cola would sponsor a good thing probably gives them a good company glow, doesn't it?

My colleague Bridget Kelly in Australia did a study on this topic of sort of the glow that sponsorship produces. In her study, she showed that about 68 percent of kids in the sample could remember the sports sponsor and thought the sponsors were cool and generous. And they wanted to sort of pay back the favor by purchasing the products of that sponsor. There is something really special to to that relationship in the minds of kids.

Wow. That's an impressive finding. So, speaking of findings, you've done some research on these sports sponsorships yourself. Can you tell us a little bit about what you've done and what you found?

Some of our work in this area has documented how food and beverage companies associate themselves with sports on the sponsorship side. Athletes and supermarkets with product partnerships. And in one of our studies that tied into sports sponsorships, we looked at the 10 major sports organizations that had a lot of viewers. So, things like the NFL, the NBA, and then we wanted to categorize what kinds of groupings, the sponsors belonged to an automotive brand. Ford motors was one of the largest categories. But food wasn't very far behind. We saw about 19 percent of sponsors were associated with food and beverage brands, and it was for mostly unhealthy items.

In the sports sponsorships, we're not. Seeing a lot of water being featured. It's a lot of sugary beverages you know, chips and things like that. We're not seeing much fresh fruit. And then when we did the same thing with athlete endorsements, one of the things that stood out about that study, which looked at a hundred athletes to get a sense of what are they endorsing and how healthy is this stuff and how much are people seeing it. The most striking finding for me from that study was that 93 percent of the beverages that were endorsed by professional athletes were sugary drinks. And we know that athletes need to drink a lot of water to sort of fuel themselves. And maybe sometimes they do need some sort of sports drinks for long workout days, but we saw a lot of sodas in the mix too and the other thing is that most kids don't need lots of sports drinks in their diet, but that's what is sort of being promoted through these through these endorsements, and so that really stood out to me about that study.

We also in a couple of these studies found that young people are often seeing more ads for this than adults. It's not even though it may be sort of targeting general audiences. A lot of times young people are really seeing a lot of these, including the forms of ads that pop up on YouTube because we know kids are really into social media. It's really across the board of all of our research. We find mostly unhealthy products being promoted through these partnerships with sports.

I remember back over the years that this issue comes up in the press occasionally and athletes get called out, specific athletes will sometimes get called out for promoting these kinds of foods. And, and I remember there being a couple of cases, although I don't remember the names of the athletes involved, where they've refused to do this kind of thing and they've made public statements about that. What's your recollection about that?

We were really excited one time with our athlete endorsement study that came out a couple of years later. Brita water filters issued a press release and I remember getting a lot of messages about it telling me to go and look at what was posted online. Brita had cited our study that most beverages promoted by athletes are sugary beverages.

And that's why we're so excited to partner with Steph Curry to promote Brita water filters. I framed that press release and shared it with all our team members who worked on those projects because it was an example of choosing a healthy beverage over some of these sugary drinks that are so commonly promoted.

So maybe there will come a day when LeBron James or athletes like that start advertising cucumbers or radishes or something.

And I wish cucumber producers had the same budgets as these sugary drink brands because it's really hard for some of the healthy stuff to compete with some of these major fast food and sugary drink companies.

For sure. Let's talk about the issue of branding, why a company like Coca Cola wants its brand image, that famous Coke logo out there in front of as many eyes as possible. Give me just a minute if you will. And I'd like to describe something that I've heard. Sort of observed over the years. It's my anecdotal impression that if you ask random people, are you a Coke or a Pepsi person? You'll get an immediate and definitive response. People know whether they're a Coke or a Pepsi person. But if you do research, you find that people can't very often tell the difference between Coke and Pepsi. And, going back as, as long as 1949, there are scientists who have done these kinds of studies on whether consumers can distinguish those two beverages, doing blind taste tests. A typical finding is that people aren't any more accurate than chance. And there was a fascinating brain scan study done much more recently, of course. When Coke and Pepsi were given to people and they didn't know which they were receiving, the brain scan showed similar brain activity for the two beverages, again, suggesting that people can't distinguish the difference. But when people knew they were drinking either Coke or Pepsi, there was a brain activity advantage. For Coca Cola, which of course is all about more marketing, bigger company, that kind of thing, I'm assuming. So based on this, it looked like Coke hadn't won the taste war, but the branding war. So why in the heck would people feel so strongly that they can tell the difference between these beverages when they probably can't?

Now my own two-bit theory on this is that no one wants to feel like they're a pawn of marketing. So, it'd be hard to admit that they favor one brand over another because then they would feel manipulated. They must believe in their own minds there's an objective difference. My theorizing aside, tell us about the power of a brand as opposed to a product and how the Olympics is such a golden opportunity for the Coca Cola brand.

When we think about a brand, it's really a combination of feelings, ideas, and the emotions that we tie into what it means to be part of that brand. And as people, and especially as young people, for let's say teenagers, they’re in an identity development stage where it's important for them to be adopting brands that are important to them, in part to distinguish themselves from their parents, to fit in with peers, and to start to have a sense of who they are as a person.

And one of the ways to do that is to associate with what you like for music, but another piece is brand. So, are you a Coca Cola or a Pepsi person? A Nike or Adidas person. That comes with all sorts of adjectives about what it means to be on one side or the other. When we think about Coca Cola as a brand linking up with the Olympics, it's an opportunity to potentially borrow, not only get their brand out there, but potentially borrow from the brand of the Olympics as well.

In our field, there's something called brand image transfer. This is the idea that when two companies or organizations partner together, the brand feelings we have about one might bleed over into the other and vice versa. It’s one of the things that's always fascinated me about this topic, and I'd love to hear your thoughts on it too, is this idea that the sports may have a sort of health piece to their brand identity. So, the Olympics have people at the peak of their, their sport. And my question has always been, what does that do to the way people feel about Coke in terms of its healthfulness? And is there some brand image transfer that's happening back and forth that's particularly beneficial for Coca Cola because of the health component?

You reminded me of something. Tell me if you think this is an interesting parallel. When I was a boy in public high school growing up in Indiana, I don't think there were any soft drink machines in my school, maybe one in the teacher's lounge or something that I never saw, of course, but there wasn't much. And then when my son, many decades later, was a student in a school, public high school in Connecticut, he and I walked around the school and counted the number of soft drink machines, and he was of course embarrassed to be walking around the school with his dad. But aside from that, I think we found something like 13 or 14 or 15 machines. I don't remember the exact number, but it was striking. And I've heard people speculate that the companies don't care that much about what's being sold in those machines because. It's not a huge profit center for them and they must split the profits with the school somehow, but it's all about the branding. And even the students who aren't buying anything from the machines walk past them probably many times a day. So, what's getting imprinted doesn't have much to do potentially with. A specific type of product, but it's just that company's main image. Does that make sense? And why those school sponsorships have been so important?

It does, and it's really, there's really an emphasis on wanting a sort of 360 level of involvement in young people's lives because if a brand can get themselves in front of kids at school, at a sporting event, in a movie, in a video game, on social media, they're immersing themselves in a way that allows the brand to keep itself top of mind.

And that's what starts to get people to be aware of it, build brand loyalty, reach for the product because it's, they, with so many ads, the ads are all competing for attention but being immersed in schools is just one aspect of that idea of having involvement in as many areas of kids’ lives as possible.

I think in addition to all the machines, there were tables outside that had. Coca Cola umbrellas, and then the football stadium had a scoreboard that had Coca Cola that featured prominently on it. It was like complete corporate capture. It was amazing how many exposures the typical student in that high school in Brantford, Connecticut would have had. And that's just in school. I mean, think about all the other things added to that. That's amazing, isn't it?

One of the things that interested me about this work was because when I played soccer and ran cross country and track as a kid, everything. There were so many instances where everything was sponsored. There were so many instances where unhealthy food products were linked with sport. So, we were the Snicker state champions of the state of Florida for soccer. I was a Wendy's high school nominee, not a winner. Let's be clear. And every brand. I have so many patches at home with fast food or sugary drink logos on them, right alongside.

And then probably not coincidentally, I remember when I was a young kid, and we were painting a piece of wood in the backyard. And I drew the Coca Cola logo with a soccer ball and a basketball next to it. Looking back, first, what an odd kid I must have been to draw Coca Cola’s logo, but to your point, I was really immersed in it and Coke was top of mind.

The kind of sports sponsorships that you talked about being exposed to when you were young. That kind of thing's happening outside the U.S. a lot too, isn't it?

It is. So, the sports sponsorship outside the U.S. – one of the big ones that comes to mind if McDonald’s sponsorship of the World Cup. We see a lot of international presence with brands, whether it’s through social media, and the way they sort of take local culture and tailor it to sports marketing. I remember being on a trip to Trinidad with my family. My mom's family is from Trinidad. And there was a Coca Cola bottling plant, I think it was. And alongside the perimeter was a painted fence and it had the Coca Cola logo and the Trinny flag and then a painting of a soccer ball and steel drums. So, there was this infusion of the culture alongside the Coca Cola logo. And that really, I think, accelerated my interest in understanding how these brands are capitalizing on the good feelings that people have towards their own culture.

It can be challenging to do anything about this and challenging, especially you regulate advertising in the U.S. because of protections provided for commercial speech through the first amendment. What can be done about the ads promoted through these unhealthy sports sponsorships?

One of the things I think we need more research on is the extent to which these kinds of ads might be contributing to a sort of misunderstanding about the health profiles of products. And so, I think that would help us better understand for kids, do they start to really think that some of these sugary drink products are healthier than water, for example.

That's just a random example but I think that will help us understand what's at stake when it comes to the impression that it's making on young people. And there's a little bit of work in this area, but more is needed. And then I think too about how as a society, there's policy regulations to it too, but that's very hard to do because of commercial speech protections. I will say one of our colleagues Nick Freudenberg has talked about how we should have an open mind with whether there's a possibility to move the needle on commercial speech protections. And so that's something I'd love to keep exploring with people on what that could look like it, and if it was possible to any extent.

And then the other thing that's always been on my mind is the idea that for some products being associated with and became a public relations liability. If we think about the way professional athletes used to endorse tobacco products and would be standing in their uniform with a cigarette in their mouth. Then that sort of became uncool. Not good for their brand. Not good for their look, and they moved away from it.

Will the same thing happen to sugary drinks and junk food partnerships. And I think sometimes we see glimmers of that. There was the famous video, years ago after a soccer game, when one of the world's most famous soccer players pushed away a sugary beverage and said agua in response. And it affected the market shares at that moment. I think there are instances like that, that we can think about in terms of getting some momentum behind the way athletes themselves identify with these products.

In that context, do you think parents could be an important advocacy voice? Let's just say that parents rose up and said to the local high school, we don't want Coca Cola stuff blasted all over our school. And they're pushing that. Coca Cola retains the right, because of the First Amendment to market its products, but local schools would have the right not to sign contracts and therefore deprive the company of those kind of marketing opportunities. Do you think parents might ever feel mobilized enough incensed enough to do something like that?

I think parents are a key factor in this issue of sports marketing to kids because companies care a lot about what parents think. Even though kids have a ton of pester power, where they nag their parents to purchase things, parents are also in many cases, especially for young kids, the gatekeepers of all these purchases. Companies know not to make parents too angry about something because of the risk of not purchasing their products. I think if parents got vocal about it, whether it's on social media or by getting involved in petitions that might be going around that's one way to get companies to start paying attention to these things because I think it getting them out of schools, for example, seems to me to be a common sense start to it and but many parents might not be thinking of this in the way, that how deeply it might be affecting their diet, their kids diets.

Bio

Dr. Marie Bragg is an Assistant Professor at the NYU Grossman School of Medicine where she also serves as the Director of Diversity Initiatives. She holds an affiliate faculty appointment in the Marketing Department at the NYU Stern School of Business, and directs the NYU Food Environment and Policy Research Coalition, which includes 56 faculty who study food and sustainability across 14 departments in 8 schools at NYU. Dr. Bragg’s research examines unhealthy food marketing practices that target youth and communities of color. Her current NIH-funded grants assess how advertising on social media affects the preferences and food choices of adolescents. Dr. Bragg is a Food Leaders Fellow at the Aspen Institute, and has testified on three public policies in New York City that aimed to create a healthier food environment. Since 2008, she has mentored more than 100 students, postdoctoral fellows, and junior faculty members. Dr. Bragg earned her PhD in clinical psychology from Yale University.

Today we're talking about who has access to full-service supermarkets in America's cities, suburbs, small towns and rural communities. According to The Reinvestment Fund's "2023 Limited Supermarket Access Analysis Report," 8.5% of people in the US live in areas with limited access to full-service supermarkets. This means that families must travel further to get fresh foods, and it creates a barrier to adequate nutrition. This is the 10th year The Reinvestment Fund has published the "Supermarket Access Report," which provides data and context about grocery store access across the country. Here to discuss the latest figures is policy and analyst Michael Norton.

Interview Summary
 

This is a really interesting and kind of nuanced topic, so I'm happy we can talk about it in some detail. Why don't we just start off with kind of a broad question. What do we know now about areas of limited supermarket access in the US?

Kelly, I think the big thing to take away at the very beginning is that the share of people living in places that would be considered low access is roughly the same as it's been over the past 10 years. We have about 8.5% of the population living in low-access areas across the country. That's pretty consistent to what it's been for over a decade. But what's important is that how low-access areas are distributed across the country varies quite a bit. And where they exist, the density of the populations where they exist, really informs the kinds of interventions that are available for addressing these needs. These vary considerably in different parts of the country and at different geographic scales. And what I mean by that is suburban areas, rural areas, and then some of the most remote areas across the country. So we do have a sort of consistent number or share of people. The actual number has gone up a little bit because the population has continued to increase. They become distributed in different ways that follow different kinds of development patterns, on the one hand. But then also places where you end up getting patterns of residential and racial segregation in more developed parts of the country.
 

It's so interesting. So, given that the average has stayed essentially the same over the 10 years you've been doing the reports, have there been pressures pulling in either direction that might have changed over the years? So, for example, are there pressures that are making access to full-service supermarkets less likely? Are they pulling out of some places, for example? And might that offset by some positive developments in other areas? So, while the average stays the same, the contours look different?

I think the way to think about that is that we see a lot of expansion of low-access areas in the big metro areas that are expanding the fastest. So, the biggest increases in populations living with limited access are in big state in the South and out west in places like Arizona, Nevada, Texas, where you have these large metros that are growing at a really rapid rate. And the reason for that is that oftentimes residential development will show up before commercial development. So, in those kinds of places, food retail is trailing behind residential development. And probably those places are going to be well served by the time we update this analysis again in four or five years because of what those development patterns look like, right? So, when you're building more houses in more urban and remote areas, there's still folks who are first in buying out in those places. They're still going to have to go a long way to get their groceries for a few years until supermarket identifies this as a place where there's going to be enough demand for us to put one of our Krogers or Targets or Walmarts or what have you. But we've also seen, and this is more common in urban places, is the expansion of these low-access areas that have smaller populations, right? And so these are places with between 1,000 and 5,000 residents where folks are still having to go disproportionately far to get access to a full-service grocery store. Sometimes this is because stores have pulled out in these places because of limited demand, historically. And that limited demand is mostly because folks don't have as much income to spend on their groceries, right? And we see these little areas popping up within metro areas and even in some close-in suburbs and places across the country. And so you have sort of these bigger LSA areas, which have at least 5,000 residents on the outer edges of a lot of metros and in some within the cities, but mostly within the cities. It's these smaller, limited access, low population areas. And this differentiation of the type of low-access area is something that we introduced in this update to our analysis that previously wasn't available. It provided a really nice nuance to understanding what limited access to supermarkets looks like going forward, both within urban places, suburban places, and in some of these really remote parts of the country.

So, based on this research, what does it tell us about the future of insecurity in the United States?

I think what it really tells us is that it depends on where you live and what kind of community you live in and what that's going to look like. I think the ability to provide a little bit more nuance around who has access and when they have limited access, what about their community is going to inform the response to ensuring that folks are able to get what they need. In places where they are these traditional sorts of limited supermarket access areas where you have at least 5,000 people, they can become pretty good candidates for operating a full-service store, right? But when you think about urban parts of the country where you've had central business districts or neighborhoods sort of hollowing out in different places and local supermarket is closed, but there aren't enough people there living to support a full-service store, different kinds of interventions are required, right? And then in these really remote parts of the country where you don't have very many residents, but you have at least a thousand, but people are living a long way away from each other, how do you serve those places? Because some of them, these are very small towns, right? And there are people who have been living there and if the grocery store closed, then they have to drive 35-40 miles to the next town, right? That becomes a real challenge for their general way of life. I think really thinking about the future of food access and food insecurity in this country really has to have a geographic nuance to it in thinking about the appropriate responses that are going to meet the needs of people living in different parts of the country.

So, how does your study inform investments do address food insecurity?

Reinvestment Fund has a very active retail portfolio, both on our lending side, and Reinvestment Fund is also the national fund manager for USDA's Healthy Food Finance Initiative. These two avenues through which we make loans to increase access to fresh food and through USDA's HFFI program are opportunities to innovate. The USDA's Healthy Food Finance Initiative is both a grant-making and a lending program that is designed to identify innovative responses to access to fresh food in these different types of areas. So, we're able to use the results of these analyses to identify places where you can align the kinds of programs that people are proposing. Whether that's a small format store in a city where their primary supermarket has closed, whether it's a mobile market that is serving folks who live very far distances from their nearest food retailer, or whether it's setting up a aggregation site that is not just food retail but sometimes is attached to a healthcare center or a hospital where people are also making regular trips. These become opportunities for us to support innovative approaches and also try out different things. Once you start to get some information from successful programs that are coming out of the grant program, as they become investible and scalable at a store level when you become ready to take on debt to expand your operation or open a store in a place that typical operators aren't willing to go.

So, let me ask you a question about the Healthy Food Financing Initiative. With politics being so partisan these days, is this a partisan issue as well, or is there bipartisan support for things like this?

This is the good news part of access to fresh food. It really is a bipartisan issue. Healthy Food Finance Initiative was created under the Obama Administration, was expanded under the Trump Administration and has been expanded even more under the Biden Administration. Each subsequent farm bill has expanded the capital available for the Healthy Food Finance Initiative, with the goal to try and figure out how do we meet the food access needs of everybody in this country in a way that provides a signal to private market operators that they can be successful in these places.

That really is a bit of good news, and I'm really happy to hear that. But I also wanted to ask you, are there options aside from full-service supermarkets to help address some of these matters you're discussing?

Absolutely, absolutely. And these are things like smaller format stores, almost like a corner store but that operates like a healthy food market. And these are really appropriate in places where there are limited access, low population, and sort of filling in pockets inside urban communities and close-in suburbs. There are mobile market options that are popping up in different places. Food aggregation hubs that will be cited within the center of a low-access area where people can come to a central location and having purchased food online that shows up and then people can come and pick it up. There's expanding delivery options to more remote parts of the country. So, there is a wide diversity of models that are proliferating beyond just bricks and mortar traditional grocery stores. It's really the job of HFFI to seed these initiatives, identify the ones that are doing really well, and then work with the folks who created them and then others to scale them down the road into places that are not served by food retailers.

I think you've helped answer the next question I was going to ask, which is how does this research help policy makers and practitioners think about addressing food insecurity in their community? There's a fair amount of tailoring that could go on where you're trying to meet the needs of a specific community.

That's right. And I think one of the things that's important to keep in mind is the role that financial institutions like Reinvestment Fund play in making this possible. So, Reinvestment Fund is a community development financial institution, which is best understood as like a nonprofit bank. And these exist across the country and are more or less active in different markets, but they're really focused on working in a very deliberate, hands-on way with our borrowers to create access to fresh food in places where it's not going to be easy, right? Because if it was easy, all the big food retailers would be there, right? So, we have to be patient. You have to find someone who's willing to take a chance operating the store, to help them develop their business plan, help them identify all of the ins and outs that go with standing up a food retail business, and then work with them throughout the process of them sort of getting access to capital and making their business work. And that work is a lot more work than what is required to finance a new grocery store that is run by Target or run by Walmart, Krogers or something like that. This is a critical role that the CDFI industry is playing and increasingly recognized at the federal level as a resource for deploying public subsidies through the private market into the hands of operators who are going to make it work in places where traditional food retailers and capital just won't go.

Let me ask a big-picture question. and this is a little complicated in my own mind. So, we're sort of defaulting in a way to the idea that full-service supermarkets providing access to such things for more people is a good outcome. And from a social justice point of view, it's unquestionably true that people who live in different sets of financial circumstances should still have access to things that people in better financial circumstances have. But in terms of nutritional outcome, having access to a full-service supermarket brings a lot more than just the healthy foods. And in today's modern full-service supermarket, the highly processed, less healthy options must outnumber the healthy ones 10 to 1, 20 to 1, 50 to 1? I have no idea what the number is, but it's enormous. And so, providing government support and financial incentives for a big store to come in is providing access to a lot more than healthy foods may have adverse nutritional outcomes rather than positive ones, unless you're just sort of agnostic about the type of food that people are getting access to, that any food is better than nothing if you have food insecurity. But I wonder how one might address that. And whether one could think about providing resources that were structured differently to encourage smaller stores, for example, that focus on more healthy options and fewer of the less healthy ones. And then you might get the social justice part addressed at the same time you're having a better nutritional outcome.

Kelly, that's such a good question, and one that we wrangle with all the time. Because there is actually fairly limited evidence to suggest that access to fresh food is going to lead people to make healthier choices about what they consume. One of the sort of operating assumptions is that in the absence of access, you're not going to make healthy choices. And once there is at least access, the possibility for making healthier choices increases from, zero to something, whatever it is that is going to be motivating individuals how they go about making choices for the foods that they consume. And it is a very tricky relationship that folks in the food industry grapple with all the time as well in the medical profession. I think from a grant-making standpoint and a financing standpoint, Reinvestment Fund's position is always that whoever is receiving support through our programs or from our lending capital is offering a selection that meets what you would consider healthy food retail options, right? That there is an assortment of fresh fruits and vegetables, fresh produce, fresh meats and dairy, in that also with the understanding that almost all food retailers are also going to offer less healthy options. That is a constant tension within the field. And figuring out how to encourage behavioral change by consumers is sort of beyond the ability of HFFI to move. What we can do is ensure that the organizations and the individuals who we support are offering a variety of healthy options for the patrons that are coming into their locations.

BIO

Michael Norton, Ph.D., serves as Chief Policy Analyst at Reinvestment Fund, and supports all research related to Reinvestment Fund’s organizational goals and mission. In this role Dr. Norton works closely with a range partners, including small non-profit organizations, local and national philanthropies, private companies, colleges and universities, school districts, federal, state, and city governments and agencies. His work leverages nearly a decade of experience as researcher and project director to develop data driven solutions – solutions that meet the unique needs of Reinvestment Fund and our key stakeholders in the public and private sectors. Dr. Norton completed his doctoral studies in the Sociology Department at Temple University, where his research examined the relationship between secondary mortgage market activity and neighborhood change in the Philadelphia region at the turn of the 21st century. Prior to joining Reinvestment Fund in 2015, Dr. Norton served as a Senior Research Associate at Research for Action in Philadelphia. In this role, he led and co-led a range of mixed-methods evaluations of educational reform initiatives and policies at the local and state levels.

Nonprofit organizations can play a very important role in building healthy communities by providing services that contribute to community stability, social mobility, public policy, and decision-making. Today we're speaking with Kathy Higgins, CEO of the Alliance for Healthier Generation. The Alliance is a nonprofit organization, a well-known one at that, that promotes healthy environments so that young people can achieve lifelong good health.

Interview Summary

Kathy, it's really wonderful to reconnect that you and I interacted some when you were in North Carolina and head of the Blue Cross and Blue Shield of North Carolina Foundation, and then you got called upon to be the CEO of the Alliance, a really interesting position. It's really wonderful to be able to talk to you again. Let's start maybe with a little bit of the history of the Alliance for a Healthier Generation. Can you tell us a bit about how it got started and over the years, how it's evolved?

We've existed for almost 19 years now. We celebrate our 20-year anniversary next year. And we were started by two vital public health forces: the Clinton Foundation and President Clinton and also the American Heart Association. They came together 20 years ago and began discussing childhood obesity and what could a leading public health organization do to really work in systems change across the country at a local level. It is those two organizations that we look to as our founders and who helped us advance our work.

It's a time flies story because it seems like just yesterday that the Alliance was created. There was a lot of excitement at the time for it, and over the work. It's done some really interesting things. So, in today's iteration of the Alliance, what are some of the main areas of focus?

As I mentioned, we are a systems change organization. What we do is take a continuous improvement approach to advancing children's health. So, we are working typically in schools or after school time and certainly in communities to work on policy and practice change that are about promoting physical activity and healthy eating. And then addressing critical child health and adolescent health issues, which as we know, were exacerbated with the pandemic. Things like food access and social connectedness are just so important. Quality sleep, which our children are not getting enough of, or other things like vaping and tobacco sensation and on time vaccinations. Another thing that we know is that the pandemic had a dramatic impact on families and children on time vaccinations. So, this is the work that we do and working with the policy and practice change so that there there can be opportunity for healthy environments for the children.

I think most everybody would probably agree that the targets that you're working on, healthy diet, physical activity, smoking, vaping habits and things like that are really important. But people might be a little less familiar with what you mean by addressing systems. Could you give some examples of what you mean by that?

Right. What we know is that in United States, in fact, every public school must have a wellness policy and areas that need to be addressed. But what we'll do is work with the school in making sure that those policies are best suited for the families, the community, and the school, and what they want to do to support the health of children from a collaborative and supportive role. What we know is that we can create great change when that occurs. We work with more than 56,000 schools across the United States, and one of the things that we know is that our approach is really reflected in the America's Healthiest Schools recognition program each year.

It's interesting to hear you talk about schools as an example of system change. And boy, working with 56,000 schools is pretty darn impressive. And it allows for out-sized influence of an organization like yours because if you can affect things like these school wellness policies and that gets multiplied across a ton of schools, it can really affect a lot of children.

Exactly. We will work school to school, but we also work in districts and that allows us then to make even a bigger impact in the number of schools that we're reaching with these changes. It also brings the community together because then they're all operating under the same principles or the same focus areas of the work that they're committed to doing. What we do see is that we're able to assist them in implementing what are typically best practices in all sorts of topic areas. Whether it's strengthening the social emotional health and learning environment for the children, but also focusing on staff wellness. The whole notion, Kelly, of putting your oxygen mask on first before assisting others is something that has been incredibly important to us. We've certainly been very supported to do that work from a variety of funders. The other area that we've been able to make great strides in is this increasing of family and community engagement, which has been really significant for us. We've been honored to have Kohl's as a major supporter of our work. Their investment and then reinvestment and then once again, another reinvestment, really helped us engage with strategies that focused on increasing family wellbeing. So really then our three-legged stool becomes the school environment, the family environment, and the community environment, which we find is just really effective.

So can we talk a little bit more about the community engagement and why is it important and how do you go about making it happen and what sort of impacts do you see it having?

I think I may have mentioned already that we do use a continuous improvement model that we find is just really effective for when we're working in the school or school district level. It allows us to serve in a role of being a convener and bringing people together. What we know now is certainly after COVID that schools are no longer for walls of learning. They have a central role to the health of the community because of the services that they're providing or the services that families need them to provide. So, when we're working with a school, we're able to convene the right people that are in their community. They may be in the same zip code, they may be down the street, they may be across town. But they haven't come together around the same table to start to address issues that they may have prioritized that are impacting a host of things. It could be impacting attendance rates, it could be impacting academic achievement. And we're really able to work with them to dismantle the barriers to what would lead to success. To give a couple examples in North Carolina, in fact, we work in both Bertie and Roberson County and on vaccination adherence, and also making sure that the children that may have deferred their well-child visits or their age-appropriate vaccinations during COVID that we've worked with convening just as mentioned, the right players, the right people in the community to come together. And in both those counties we've been able to have nearly 250 students that are healthy back to school and fully vaccinated as they should be and that they deserve to be and as their families wanted them to be, but the time the resources just wasn't there or convenient enough to do. And so, this really has allowed the community to have a great win. It's a great example of just the importance of sitting down together, looking at the data and thinking about how we can all make a difference.

Kathy, what you've reminded me of as you've been talking about this is that there's sort of a sweet spot that you've attained. If all you paid attention to were best practices, you'd say, well, okay, everything that works in these other places is going to work in your place, which of course might only be partially true. But if you only work locally, then you'd miss the opportunity to be learning what's happening elsewhere that might help you. And you're kind of at the intersection of these things, aren't you?

Thank you for saying that. That's exactly where we sit - at that intersection. Sometimes we feel in a continuous improvement model that there's a no wrong door, so to speak. And so, when we're engaging with a school, school community, a community, or even a school district, that we're able to sit with them in proximity and talk through what are the issues that they're facing, where their children are most at risk, and what is it that they are working to prioritize. Because we also know that if we can move them through a process and achieve success and really answer the question, is anyone better off? So to really be outcomes focused. Then, what we know is that there are other opportunities for improvement that we can continue that work. Part of the success here is just pausing and celebrating what good work this community is doing together. This school is doing together.

Tell us if you will, a little bit about how the work of the Alliance is funded, because I know you draw support from a number of quarters. You mentioned Kohl's, but overall how is the work funded?

Thanks for asking. You know, one of the things I did mention to start with is the Clinton Foundation and President Clinton, specifically with his leadership supporting the health of children and families and the Heart Association. But the significant financial supporter and strategic supporter at the time was the Robert Wood Johnson Foundation. They really put significant resources behind the creation of Healthier Generation. But the other thing that they did is put their brightest minds and public health leadership behind the creation of why we would exist and what would be the pillars of our organization that would serve well to make a difference. So having a technology backbone, which allows us to have an action center. Meaning that any school, any teacher, any administrator, any parent can access our training and our tools for free. Through our website, we have marketing and communication that follow best practices for how to create change and how to communicate change to the audiences that we're reaching out to our subject matter expertise and then measurement and evaluation. And it's this ability that really attracted funders like Kaiser Permanente. While schools have been central to our work, this digital platform really allowed our action center to help and support this access of no cost assessment tools, trainings, resources. Kaiser Permanente has been a key supporter of our work since 2013. I mentioned Kohl's as well, as such a significant supporter allowing us to reach 10 million families since the inception of our work together with them. Del Monte Foods is another significant supportive of ours. They allow us to implement the America's Healthiest School Awards program. I would be lost if I didn't mention Mackenzie Scott. She wanted to invest in whole child health equity and we were identified as an organization that was worthy of her funding and definitely was the largest single gift from a philanthropist that we've ever received. So, we were so grateful for that, that call called.

That's wonderful affirmation. No question. It's nice to hear you have such a broad base of funding because that's a sign that people are thinking you're doing things right. I'm not sure I'm in a the best position to be completely objective about this because over the years I've received funding from through Robert Wood Johnson Foundation for a number of projects. But it's amazing how often their imprint comes up when you talk about organizations that are doing creative work and you go back to the beginnings and Robert Wood Johnson was often there doing these things when nobody else was. And it's really wonderful to see the long-term consequence of that investment that they made. Well, let's talk about some new work you're doing in the schools. I know that a relatively new effort of the Alliance involves the expansion of resources in terms of a playbook in the schools. Can you explain what that's all about?

Oh yes. This was really born out of the pandemic environment and our need and the schools need to know better guidance on the work that we can do to create healthier environments when so many demands are being put on us. We all know what happened to the food service staff of any school. They became the food service staff of the community during the COVID years. Kohl's wanted us to partner with selected communities across the country to implement what would be really a new family engagement strategy to support children's health and developing. What we call and refer to as our Healthy at Home playbook for schools to forge stronger relationships with families. We know that when schools and the families are working together and schools are understanding what families need, and families are able to be in a position to be heard and communicate what their needs are, that together they can really make a difference. We've been pretty excited the collection of resources. They're both in English and in Spanish on topics such as nutrition, staying active, mental wellbeing, social emotional health and stress and we've been pretty excited to have that implemented.

I could see how you'd be excited about that. So, let me ask a final question. The word policy has come up several times. Is it part of the purview of the alliance to argue for policy changes? You mentioned schools. So, for example, would the Alliance be in a position to argue for tighter nutrition standards in schools or even something beyond the schools, like something dealing with food marketing directed at kids or front of package labeling or really anything like that?

We stay out of the advocacy and lobbying lane, but we do focus on the small P policy change in schools so that we're helping schools manage their policies. But the area where we've had success is in creating a difference. We had a great partnership many years ago with McDonald's and worked with them on changes that they were committed to making in their healthy meals. And what we know is when McDonald's makes a big shift, so goes the market. Our body of work was the removing of sugary sodas from the menu board so that you would have to opt for that versus low fat milk or water and adding the sliced apples. I think that might be one of our hallmarks of the work that we've done over the years: sliced apples, carrot sticks, the GO-GURT that was being offered. And then removing either the higher sodium or higher fat items from the leaderboards so that they have to ask for them in order to have them as part of the Happy Meal. That was some significant work that we were able to do. And the other work we did in our early years was getting the three soda manufacturers, whether Pepsi and Coke and Dr. Pepper to agree to come together and remove sugar sodas from our public schools and replace it with a better price point of water. And it's something I know President Clinton is very proud of because I think a 90% of schools were on board with that work after about a three-year period. I think it really made a difference.

Bio

Kathy Higgins, chief executive officer (CEO) of the Alliance for a Healthier Generation, is a national expert on health care and philanthropy, having previously served as the president and CEO of the Blue Cross and Blue Shield of North Carolina Foundation. Higgins leads Healthier Generation’s team of nearly 100 professional staff across the nation working to make the healthy choice the easy choice for all children. Prior to taking on the role of Healthier Generation CEO in January 2019, Higgins spent more than 30 years at Blue Cross Blue Shield of North Carolina, where her roles span leading public health engagement, corporate communications, community relations, and corporate affairs. In 2000, Higgins led the launch of the Blue Cross NC Foundation. As president and CEO of the Blue Cross NC Foundation, Higgins led unprecedented growth, including the strategic investment of more than $150 million into North Carolina communities through more than 1,000 grants to improve the health of vulnerable populations, support physical activity and nutrition programs, and help nonprofit groups improve their organizational capacity. Higgins was also a significant advocate in Blue Cross NC’s early adoption of Healthier Generation’s decade-long innovative insurance benefit program, designed to encourage clinicians to extend weight management and obesity prevention services to kids and families. Higgins holds a bachelor’s degree in education from West Virginia Wesleyan College and completed her master’s work in community health education from Virginia Tech. She currently resides in Raleigh, North Carolina and is the mother to twin boys.

Is it possible to decarbonize agriculture and make the food system more resilient to climate change? Today, I'm speaking with agricultural policy expert Peter Lehner about his climate neutral agriculture ideas and the science, law and policy needed to achieve these ambitious goals. Lehner is an environmental lawyer at Earthjustice and directs the organization's Sustainable Food and Farming Program.

Transcript

How does agriculture impact the climate? And I guess as important as that question is why don't more people know about this?

It's unfortunate that more people don't know about it because Congress and other policy makers only really respond to public pressure. And there isn't enough public pressure now to address agriculture's contribution to climate change. Where does it come from? Most people think about climate change as a result of burning fossil fuels, coal and oil, and the release of carbon dioxide. And there's some of that in agriculture. Think about tractors and ventilation fans and electricity used for pumps for irrigation. But most of agriculture's contribution to climate change comes from other processes that are not in the fossil fuel or the power sector. Where are those? The first is nitrous oxide. Nitrous oxide is a greenhouse gas about 300 times more potent than carbon dioxide. And it comes because most farmers around the world and in the U.S. put about twice as much nitrogen fertilizer on their crops, on the land, as the plants can absorb. That extra nitrogen goes somewhere. Some of it goes off into the water. I'm sure your listeners have heard about harmful algae outbreaks or eutrophication of areas like the Chesapeake Bay and other bays where you just get too many nutrients and too much algae and very sick ecosystem. A lot of that nitrogen, though, also goes into the atmosphere as nitrous oxide. About 80% of nitrous oxide emissions in the U.S. come from agriculture. Excess fertilization of our hundreds of millions of acres of crop land.

Quick question. Why would, because the farmers have to pay money for this, why do they apply twice as much as the plants can absorb?

Great question. It's because of several different factors. Partly it is essentially technical or mechanical. A farmer may want to have the fertilizer on the land right at the spring when the crops are growing but the land may be a little muddy then. So they may have put it on in the fall, which is unfortunate because in the United States, in our temperate area, no plants are taking up fertilizers in the fall. Also, a plant is like you or me. They want to eat continually but a farmer may not want to apply fertilizer continuous. Every time you apply it, it takes tractor time and effort and it is more difficult. So they'll put a ton of fertilizer on at one point and then hope it lasts for a while, knowing that some of it will run off, but hopeful that some will remain to satisfy the plant. There's a lot of effort now to try to improve fertilizer application. To make sure it's applied in ways just the right amount at the right time. And perhaps with these what's called extended release fertilizers where you put it on and it will continue to release the nutrients to the plant over the next couple of weeks and not run off. But we have a long way to go.

Okay, thanks. I appreciate that discussion and I'm sorry I diverted you from the track you were on talking about the overall impact of agriculture on the climate.

I think what's so exciting about this area is that everyone cares about our food. We eat it three times a day or more and yet we know very little about where it comes from and its impacts on the world around us. It's wonderful to be talking about this. The second major source of climate change impact in agriculture is methane. Methane is another greenhouse gas much more powerful than carbon dioxide. About 30 times more powerful over a hundred years and about 85 times more powerful than carbon dioxide over 20 years. Which is I think the policy relevant time period that we're looking at because we're all trying to achieve climate stability by 2050. And where does methane come from? A little bit comes from rice, but the vast majority of it comes from cows and from manure. Cows are different than you and me. They can eat grass, and their stomachs are different, and release methane. Every time they breathe out, they are essentially breathing out this potent greenhouse gas methane. This is called enteric methane and it's the largest single source of methane in the United States. Bigger than the gas industry or the oil industry. The other major source of methane is manure. Our animals are raised in what are called concentrated animal feeding operations. They're not grazing bucolically on the pasture, they are crammed into buildings where there may be thousands, or tens of thousands, or even hundreds of thousands of these animals. Those hundreds of thousands of animals produce a vast amount of manure, whether it be say pigs in North Carolina or dairies in many States, or cattle or chicken. All our meat nowadays is grown in these concentrated areas where you get concentrated manure and that is often stored in these lagoons. These big pits of poop basically. And that, as it decomposes in this liquid environment, what's called anaerobically , releases a tremendous amount of methane. That's the second largest source of methane in the country after the cows belching. So you have nitrous oxide and you have methane. And then the third way agriculture contributes to climate change, which is different say than the fossil fuel sector, is by changing the land itself. Agriculture uses a tremendous amount of land. Think about it. When you go around, what do you see? You see agriculture uses about 62% of the contiguous United States; 800 million acres of land for grazing; or almost 400 million acres of land for cropland. Healthy land before it's been used for agriculture has a tremendous amount of carbon in the soil and in the plants. Just think about a forest with all the rich soil and the rich vegetation. When that is cleared to be a cornfield, all that carbon is lost and essentially it goes into the atmosphere as carbon dioxide. And that soil after that can't absorb any more carbon. Healthy soil is absorbing carbon all the time and most agricultural soils are not. So that release of carbon when you convert land to agriculture and that continuing inability to sequester carbon is another major way that agriculture contributes to climate change. So these three ways: nitrous oxide, methane and carbon from soil are all important contributors to climate change that don't really fit most people's model of what drives climate change - burning coal or oil and releasing carbon dioxide. But the bottom line is if we don't address agriculture's contribution to climate change, no matter how successful we are in reducing our fossil fuel use, we are very likely to face catastrophic climate change. Agriculture's contribution to climate change is so significant. Far more than the indicated by many figures. We can't achieve climate stability without addressing agriculture as well. Agriculture drives about a quarter or a third total green climate change.

Given how important this is, why don't people know more about it? And does industry play a role in that?

Industry plays a big role, as does politics. Industry - and by industry we mean the food industry. And you've covered this before. It's very concentrated industry where usually two or three or four firms control the market, whether it be for seeds or retail or beef or chicken or pesticides. It's a very, very concentrated industry with tremendous political power. They have done their best to ensure, first of all, the agriculture industry doesn't even have to report their greenhouse gas emissions. Every other industry has to report their greenhouse gas emissions. The big polluters have to report. On the other hand, agriculture was able to obtain a rider in Congress. That's an extra provision on a budget bill starting about a decade ago that prohibits EPA from requiring agricultural facilities to report greenhouse gas emissions. So unlike most areas, agriculture doesn't even have to report their emissions and industry certainly wants to keep it that way. Also, as I was explaining, agriculture contributes to climate change in a way that is different than what we normally think about. I think that added complexity has just meant it is harder for people to understand. And third, there's a tremendous amount of mythology in agriculture. People think or would like to think that their food comes from this nice family farm with a few animals and a few diversified crops on the hillside. And that in some sense was the reality 50 or 100 years ago, but now it's not the reality. While there's still lots of small farms like that by number, those produce very little of our food. Most of our food is produced in these gigantic animal factories that I mentioned earlier or in gigantic monoculture chemical-dependent agricultural operations. So, we have this disconnect between what is the mythology of agriculture and where our food comes from and the reality of it. People really don't want their myths disrupted.

Given the importance of these issues, what are some of the main ways that the impact of agriculture on climate can be changed?

That's another exciting part of this. That there's a lot of things that can be done to reduce the impact of agriculture's contribution to climate change. And we know this because there are a lot of producers who have piloted these programs, who've implemented these programs and these practices on their own operations to reduce the climate impact. And they've been successful. So these can be, for example, rotating crops instead of having the same crop year after year after year, which really depletes the soil. You can have different crops in different years and each crop puts a little different in the soil and takes a little different from the soil. As a result, very often you end up needing less artificial pesticide and fertilizer, both of which contribute to climate change. You can manage your animals different. You can manage your manure differently. For example, if manure is treated and handled dry, as opposed to in these wet manure lagoons, it produces very, very little methane. Instead of producing tremendous amounts of methane, it produces almost none. So, if we manage manure differently, we can significantly reduce methane emissions. And of course, there's what we think of as the demand side. In the same way that we think about LED light bulbs or more efficient cars as part of our energy transformation, we can use our land and food more efficiently. We waste a tremendous amount of food. Maybe 30-40% of the food we produce is wasted. That's crazy. It's all the effort and the greenhouse gases from producing the food are wasted if the food is wasted. Even worse, the food is dumped into a landfill for the most part where it releases more methane. And it's inefficient. We have a system that very heavily subsidizes meat production, but meat uses, particularly beef, a tremendous amount of land because cows need a lot of land the way their biology requires land and time. So we have almost 800 million or 700 million acres of land devoted to cattle grazing that could be storing carbon. Then it takes about 15 pounds of grain to get a pound of beef where people can eat the grain directly much more efficiently. So there's a lot of practices that we can do at every stage of the process to reduce the climate impact of agriculture. The challenge is that it's only on a couple percent of American cropland or very little portion of our food is produced that way.

So Peter, let me ask you a question about that very point you're on. We've recorded a series of podcasts on regenerative agriculture. Some of the most interesting podcasts we've done from my point of view. And they've included scientists who've studied it, policy people who look into it, but also farmers who have done this. I'm thinking particularly, well, three names pop into mind, but there are more. So Nancy Ranney, who ran a ranch in New Mexico for cattle, Gabe Brown, a regenerative farmer in North Dakota, and Will Harris from Georgia were all people we spoke to. I got the sense in each of those cases that these people were converting to this new model of farming because of what they cared about. It was their own passions that led them to do this and belief that a different system of agriculture was going to be important for the future. They were doing it for that reason, rather than any incentives from the government or policies that were encouraging, things like that. So there will be a small number of such people who would do it because they're passionate about it. I'm assuming that number will grow, but never fast enough to really do anything to scale like we really need it. So I'm ultimately you're going to need policies in place to ensure these things happen in more and more farms. Are there particular policies that are oriented this way that you think might be especially helpful?

Kelly, you are spot on. I know Nancy and Gabe and Will, and they're terrific. They are pioneers and they are showing that we know this works. We're not looking at ideas that might work. We are looking at practices that we know work because of what they and others like them have done. As you said, they're doing it because they believe it's the right thing. We'll get some farmers that way, but we need policy to move from 2% of American crop land to 92% of American crop land. So, how do we do that? One is the current farm bill is very important. The farm bill is the most important environmental law nobody's ever heard of. It dates back to the depression. It's renewed every five years. Congress is debating it right now. It was supposed to be renewed last year, but they couldn't get their act together. So they may or may not be able to reauthorize it this year. But the farm bill in one section provides a tremendous amount of money for nutrition assistance. And you've probably talked about that, what we call the Supplemental Nutrition Assistance Program. In another part of it, it provides tremendous amounts of subsidies to farmers, about $20 billion a year of subsidies to farmers. Right now, those subsidies really are not designed to encourage farmers to adopt the practices that you talked to Nancy or Gabe or Will about. These practices that I was talking about earlier and that sometimes are called regenerative, sometimes agroecological, organic farming is often a part of that. These $20 billion of subsidies though, could be redirected, reshaped somewhat and not necessarily radically, but reshaped and focused on encouraging farmers to adopt these practices that can help mitigate climate change. And importantly, the same practices, and as I'm sure the folks you've talked to said, also help them be more resilient to climate change. They can better help the producer better withstand floods and droughts and temperature extremes. So there is a tremendous upside from this. We are already spending $20 billion a year on farm subsidies. Let's start spending it more intelligently in a way that really addresses our needs.

Do you see signs that things are moving in that direction?

I wish I did. There are some signs that we're moving in the right direction. The Inflation Reduction Act, which Congress passed a couple of years ago, was the first time Congress ever linked agriculture and climate change. In the 2018 Farm Bill, there's no mention of climate change. And when we were working on that with members on the Hill, there was really no overt conversations about climate change. Fortunately, things have changed. So, a step forward is that we're talking about climate change. And in the Inflation Reduction Act, Congress provided $20 billion to go to programs that are established under the Farm Bill. So, 20 extra billion dollars to these Farm Bill conservation programs and required that that money be spent on practices that will reduce greenhouse gas emissions, essentially help us mitigate climate change. And that, again, was the first time Congress linked agriculture and climate change. Super important. Part of what's going on now on the Hill is a fight to ensure that money that the Inflation Reduction Act provided stays. There are those in Congress that would like to raid those funds and put them to other purposes, which we think would be a big step backwards. So that was really great opportunity. As to the Farm Bill money itself, there's definitely some conversations, particularly among the Democrats, to ensure that all of the Farm Bill programs are a bit more climate-focused. But we're far from consensus on that. So, we're making a bit of progress, but right now Congress is, I think it's fair to say, not at its most functional. And so the type of policy discussions we need, and an honest discussion of how can we help American farmers shift to practices that are better for them, for the communities, upwind and downwind and around them, better for climate change resilience and climate change mitigation. We're really not yet having that conversation as robustly as we need. Hopefully we'll be able to get to a place where the politics will allow us to have that. And frankly, this podcast and other conversations are really important to educating people so we can have that conversation.

When you're trying to make policy advances, having public support for it can be a real asset. Do you see signs that the public is becoming more aware of this, that they're urging their political leaders to move on this front?

For sure. The public is very much concerned about climate change. Every poll shows that. And people are concerned about it both as citizens and as consumers. So, if you follow the food marketing world, what you see is that many surveys show that consumers are very interested in the climate impact of their food choices. And far more than was the case a couple of years ago. And they want to know how can I buy food? How can I eat food that is climate friendly, that helps us stabilize the climate? And industry is responding to that. Now, some industry is responding to that by deceptive advertising. You may have seen that the New York Attorney General recently sued JBS, the world's largest beef company, for misleading statements about the climate-friendliness of their beef. So some companies are talking more than they're doing, but others are trying to respond to consumers' interest in more climate-friendly food. You see a growth in plant-based foods, plant-based milks, because plant-based foods have a much, much lower climate impact than meats, particularly beef. And so consumers are interested in that, and that market is responding. And I think you'll see more of that in governmental procurement as well. Governments that are trying to think about how can we, say New York City, reduce our climate footprint while a big part of a city's climate footprint is the food it purchases, say for New York City schools. And a city can take action by trying to buy lower climate impact foods. And that would be foods produced in a way that you've talked about with regenerative practices and also lower climate impact, such as more plant based. So, I think we're seeing a lot of progress on that for sure.

So Peter, related to this, what would you think about some kind of labeling system on food products that gives an environmental score, let's say?

I personally like the idea of labels. I'm not an expert by any stretch. I do remember that not too long ago, New York City required restaurants to label or have on the menus the calorie content of food. And that provision was later adopted by the Affordable Care Act and now is required of chain restaurants. And Trump tried to roll that back. So we litigated to try to preserve that and get that requirement reinstated in the Affordable Care Act successfully. And during that, I learned that labels really make a difference. Calorie labeling on menus does in fact help people make more informed choices and often better choices. And there's no question, again, I'm not an expert. You probably know much more, but for example, the added sugar labels make a difference and others. So I think as a whole, labels can make a big difference. Now, environmental footprint is a complicated multifaceted issue because something may create harm to water. It may create harm through toxic, say pesticide residue, or it may have a big climate footprint. How do you put all of that into a simple label? It's a complicated question. But I do think there's interest in having particularly climate, the climate impact food be identified on the label. And perhaps we will move in that direction.

Bio

Based in New York, Peter Lehner is the managing attorney of Earthjustice’s Sustainable Food & Farming Program, developing litigation, administrative, and legislative strategies to promote a more just and environmentally sound agricultural system and to reduce health, environmental, and climate harms from production of our food. Peter is one of the leading experts on the impact of agriculture on climate change and is the author of Farming for Our Future; the Science, Law, and Policy of Climate-Neutral Agriculture. From 2007–2015, Peter was the executive director of the Natural Resources Defense Council (NRDC) and the NRDC Action Fund. Among other new initiatives, Peter shaped a clean food program with food waste, antibiotic-free meat, regional food, and climate mitigation projects. From 1999–2006, Peter served as chief of the Environmental Protection Bureau of the New York State Attorney General’s office. He supervised all environmental litigation by and against the state. He developed innovative multi-state strategies targeting global warming and air pollution emissions from the nation’s largest electric utilities, spearheaded novel watershed enforcement programs, and led cases addressing invasive species, wildlife protection, and public health. Peter previously served at NRDC for five years directing the clean water program where he brought important attention to stormwater pollution. Before that, he created and led the environmental prosecution unit for New York City. Peter holds an AB in philosophy and mathematics from Harvard College and is an honors graduate of Columbia University Law School. Peter is on the boards of the Rainforest Alliance and Environmental Advocates of New York and a member of the American College of Environmental Lawyers. He helps manage two mid-sized farms and teaches a course on agriculture and environmental law at Columbia Law School.

The first nutrition labels mandated by the Food and Drug Administration appeared on food packages in 1994. A key update occurred in 2016, informed by new science on the link between diet and chronic disease. Along the way, things like trans fats and added sugars were required, but all along, the labels have been laden with numbers and appear on the back or side of packages. There has long been interest in more succinct and consumer-friendly labeling systems that might appear on the front of packages. Such systems exist outside the US, but for political reasons and lobbying by the food industry, have been blocked in the United States. There's new hope, however, described in a recent opinion piece by Christina Roberto, Alyssa Moran, and Kelly Brownell in the Washington Post. Today, we welcome Dr. Christina Roberto, lead author of that piece. She is the Mitchell J. Blutt and Margot Krody Blutt Presidential Associate Professor of Health Policy in the School of Medicine at the University of Pennsylvania.

Interview Summary

This is a really important topic, and if the nation gets this right, it really could make a difference in the way people make product decisions as they're in the supermarket. So, let's talk first about the importance of labeling on the front of the package. Why is that important when all the information is somewhere else, namely on the side or the back?

I think there's a couple of key reasons why it's good to do front of packaging food labeling specifically. So, as you mentioned, it was a huge deal in 1994 to get this information mandated to be on food packaging to begin with, right? All of a sudden, there was much more transparency about what's in our food supply, but that being said, when you think about the nutrition facts label, it's pretty dense. There's a lot of percentages, there's a lot of numbers, there's a lot of information to process. And when people are actually in the supermarket shopping, they're making these split-second decisions, right? So, it's not to say that some consumers are turning it around and inspecting that packaging, but the reality is, for most people, it's a very habitual behavior. And so, we want to be in a place where that information is prominent, it's easily accessible, and it's easy to understand so that when you're making those snap judgements, they can be informed judgments.

So, you're not talking about taking what's on the back and just moving it to the front. You're talking about a different set of information and symbols that might be available?

That's right. Yeah. What front of package labeling is designed to do is just take some of the key bits of information that we know from science is going to be most important for consumers to base their nutritional decisions on. That's things like saturated fat, sodium, added sugars, right? And moving that to the front of the package and communicating about it in a very simple, clear way. So, no numbers, no percentages, just very straightforward language. And ideally some sort of icon, like an exclamation point, that would draw attention to that symbol and just quickly let consumers know that this product is high in those nutrients that you need to be concerned about and you need to try to limit.

Why is it an important time to be thinking about this issue in the US?

It's an important and it's an exciting time because the FDA right now is highly interested in actually moving forward on a policy that would require these types of front of package labels. And that hasn't been true, as you noted, for about a decade. But last year, the White House convened a very significant conference that hadn't happened in 50 years about nutrition, health, and hunger. And front of package labeling actually made it into their report in that conference as a key objective for this country in terms of a food policy that, under the Biden administration, they want to achieve. What we're seeing the FDA do now is actually undertake a series of research studies to try to understand what should this label look like, and how should it be designed to be consumer friendly. With the hope that actually we'll get a proposed rule on this potentially by June, and even if not by June. There's clear momentum that it looks like this is going to be happening in the near future.

In a few minutes, I'd like to ask you about what's taken place in other countries, but what's been the history of this in the US?

Front of package labeling really came to a head back in 2009. And it's actually quite a delight to share this with you, Kelly, because you and I were doing some research around it at the time. So, what played out then is a labeling system was introduced called Smart Choices. At its face, it seemed to make sense, right? It was going to be a check mark that was going to be put on products that were deemed to be healthy as a smart choice. So, a consumer could look at that and select something they wanted to eat that was relatively healthy. The reality is when that labeling system came out, it was on Fudgesicles and it was on Cookie Crisp cereal, and there was a lot of kind of concern about whether this type of labeling system was systematically problematic and was going to mislead consumers. And at that time, Kelly, I was a grad student at the Rudd Center and you really taught me quite a bit about how to make things happen and how to have a public health impact. Because we were quite concerned about that system, we actually did a study where we randomly sampled 100 products from Smart Choices and we applied an objective nutrition standard - an algorithm to score those products. What we found is that 64% of those Smart Choices products would not meet healthy by this objective nutrition standard. And so, you had the vision to reach out to the New York Times and alert the media to this. And we started to see a lot of kind of concerning reports in the media, like Smart Choices, what's going on? This doesn't seem very smart. We had done this little bit of science, and then at the Rudd Center, you had reached out to the attorney general of Connecticut at the time, Dick Blumenthal, who was quite interested in consumer protection issues and worked a lot on tobacco. And he took this up as a real public health champion to say this is concerning, we have some of this science, and he came out and threatened legal investigation into that program. What was so remarkable to see in that story, particularly for me as a grad student, was wow you can get these different actors coming together, right? Some of that media attention, science playing the role it needs to play, a public health champion who can really make a difference in the attorney general, and all of that can come together and this program literally halted, they stopped it. And I should say, that was a great public health victory. But immediately after that, the Institute of Medicine, so now the National Academy of Medicine, was charged with writing two reports on front of package labeling. And they came out with one that was focused on the nutrition criteria that should underlie a system like that, and one about the design of the label. And they had some great recommendations, very consistent with what you and I have seen in the science, right? It needs to be accessible, simple, easy to understand. Well, what ended up happening is not much. The industry at that point then released their voluntary labeling system that they call Facts Up Front, which is what we have to this day. And as you might imagine, it has percentages and it has grams and milligrams and it's confusing, and they can also highlight positive nutrients on there. So you can have a Cookie Crisp cereal that's also touting the amount of fiber, the amount of protein. And so that's really what we've been stuck with. It's now only over a decade later that we are at this moment where we're finally seeing this progress, and we're at a place where we might get a labeling system that does a really good job of communicating this information to the consumer.

I guess one sort of ironic form of evidence that such a system is likely to really help consumers make decisions is how hard the industry has fought against having such a system. And not to mention the science that exists suggesting that these things might be helpful. A lot of activity has occurred outside the US. Can you describe some of that?

Over 40 countries have front of package labeling systems. Now, some are mandatory, some are voluntary. The mandatory ones, as you might imagine, produce better effects. They range. And many of them are designed really well. So, let's take some of the best examples. Chile, for example, has warning labels that alert consumers to whether products are high in saturated fat, sugars, sodium, and calories, and those symbols are designed in a very intuitive way. They're stop sign shaped, so they really leverage the automatic associations consumers have. They're prominent, they're black, they stand out from the packaging. And these well-designed labels, we now have evidence from scientific evaluations that they're producing effects, right? They're leading consumers to purchase less of these unhealthy nutrients. They're also leading to some reformulation. And by that, I mean the industry is trying to figure out, 'well, can we lower the sodium, so we don't get one of those labels?' The other thing that I think is often overlooked with labeling but is so important is once you decide to label the food supply and you have an agreed upon system, that can support other policies. And that's what we see in Chile as well. Now all of a sudden, you can't market foods with these warning labels to kids, right? And you can't sell those foods with these warning labels to kids in schools. So, it really has even a broader impact than just the behavior change you see from the labeling, and so many other countries have followed suit. Mexico has a very similar labeling system. One thing that they've learned from Chile is, and this is a concern, that as the industry brings down the levels of sugar, for example, in foods in response to labeling, they're increasing the levels of non-sugar sweeteners, right? Things like Sucralose or Stevia or monk fruit, and so that's a worry. Mexico has, in addition, also labeled those non-sugar sweeteners on the food packaging. And then you see other examples. France has a really nice system. It's called Nutri-Score. Very intuitive. There are letter grades. I myself had the chance to go to France. I was trying to buy some turkey for my son. I don't speak a bit of French, and I'm standing in the supermarket and I just see the letter grade A and I think, oh, okay, I'll pick that one.

Great, great example.

Yes, very intuitive systems around the world.

So, are there studies showing which of these systems work and what sort of effects they have? And I know you've done additional work beyond what you mentioned earlier.

Absolutely, and there are a whole range of studies, whether they're randomized controlled trials, lab studies, or online experiments. And then the more compelling, convincing evidence, which comes from natural experiments that are done around the globe, or even research we have from stores that have voluntary implemented these labels and we can look at changes in sales data. And what all that boils down to is labeling will produce behavioral effects. They will get people to purchase healthier foods, they will get people to purchase less of the unhealthy foods. Labels inform consumers, which I think is kind of the first order goal, right? Like let's just make sure people understand what's in the food supply, and then we see this reformulation. And that's been true, even if you look back to trans fat labeling, like requiring trans fat on the labels was also associated with trans fat coming out of the food supply. So, I think we can feel really good and solid that labeling can help people make healthier choices. And as anyone who's worked on issues related to chronic diseases, we're going to need a suite of policies, right? Labels are never going to be the silver bullet. They're not designed to be, but it's a policy that makes a lot of sense. It's a very cost effective policy. It's not very expensive to do labeling, and it can help support many other policies that might produce bigger effects.

So, given the different options, the different kind of systems that have been proposed or are out there in use, do you have a sense of what ultimately might be the best system?

I think the FDA has some good options in front of them. Now, if I were to wave a magic wand, I would do warning labels. I would make them more similar to what's done in Chile, just because we have good evidence that warnings in particular, and these kinds of symbols like a stop sign, are probably going to be more effective at educating consumers and shaping behavior. Now, that being said, we have some unique legal challenges in the US for getting a system like that. The FDA is proposing, I think, a totally reasonable, science-based label that essentially would have what it's high in and then indicate whether it's high in added sugar or saturated fat or sodium. I would love to see that label also have some sort of icons, some eye-catching exclamation point or something like that, but that label is great, it's a great option. Let's compare it now to what the industry is pushing for, which is basically what we have now, facts upfront. And as I said earlier, this is a label that has percent daily values, that has grams, that has milligrams, that can highlight positive nutrients that are going to appear on unhealthy foods. I think when you look at those two options, it's just a no-brainer to go with this very simple, very straightforward, high-end label that lists the nutrients and let's put some sort of icon on it.

So are you optimistic about where things might go?

Well, I'm a glass half full kind of person. I would say yes, I try to be very optimistic, but I think there's reason to be. I think we have some good options on the table, FDA is moving forward, research is being done, scientists and others are highly engaged in this process and giving feedback to FDA. And so many other countries have done this. So yes, I am feeling optimistic.

So at the end of the day, a lot of this will come down to how much the FDA can resist pressure from the food industry.

Right, so many things in food policy do come down to that.

That's really true. So true. It's interesting, one of the things that you highlighted, but I'd like to even bring a little more attention to is the issue of the industry reformulating its products so that they don't have to show these negative labels. That's such a potentially powerful public health consequence of this, that it needs to be focused on even more. I'm hoping the valuations are being done of the impact of that on public health. Because you can make an argument, couldn't you, that if these labels don't affect the purchasing behavior of a single individual, they still could have enormous public health benefit just because of the reformulation, do you agree?

Oh, 100%. Yes, absolutely. I would even argue that we have very few mechanisms to hold industry accountable, and to me is just a fundamental right of consumers. Like they have the right to know, there needs to be transparency, and great that they are likely to produce behavior change and great that they are likely to make the industry reformulate, but I just feel like that there's so many reasons to do labeling that it just feels like an obvious policy to pursue.

Hopefully, any system that comes into place can be nimble as much as they can be in these government regulations to take into account new science that occurs. Like at some point, maybe a symbol that notes whether a product is ultra processed would be in order, or as you said, in France, I think it was, where they've labeled the addition of the artificial sweeteners. Was it France or was it another place?

Mexico. Yes.

That's right. Okay. Yeah, thanks for clearing that up. Something like that might enter the system, so having a system that can adjust to the science as it goes forward would be really important too.

Kelly, it's such an important point. I think part of any labeling strategy needs to be monitoring and evaluation, and particularly with the non-sugar substitutes. Like right now, we don't know, it's a very hard thing to track. It's only on the ingredient list. We can't quantify how much is in the food supply. And so I would love to see coupled with labeling some way that that gets disclosed so we can really monitor and ensure how that might be changing in the food supply over time and evaluate, to your point, what's happening in terms of reformulation.

As an aside, we've done a cluster of podcasts on the influence of these artificial sweeteners and the sugar substitutes and the available science on this, on what goes on in the brain, what happens to the microbiome, the impact of health overall is really concerning, so I totally agree with you that having that information disclosed could be really helpful.

Yes, 100%.

BIO

Christina A. Roberto, PhD is the Mitchell J. Blutt and Margo Krody Blutt Presidential Associate Professor of Health Policy at the Perelman School of Medicine at the University of Pennsylvania. She is also an Associate Director of the Center for Health Incentives and Behavioral Economics (CHIBE) at Penn. Dr. Roberto is a psychologist and epidemiologist who studies policies and interventions to promote healthy eating habits and help create a more equitable and just food system. In her work, she draws upon the fields of psychology, behavioral economics, epidemiology, and public health to answer research questions that provide policymakers and institutions with science-based guidance. Dr. Roberto earned a joint-PhD at Yale University in Clinical psychology and Chronic Disease Epidemiology. Dr. Roberto completed her clinical internship at the Yale School of Medicine and was a Robert Wood Johnson Foundation Health and Society Scholar at the Harvard T.H. Chan School of Public Health.

Traditional clinical weight loss interventions can be costly, time consuming, and inaccessible to low-income populations and people without adequate health insurance. Today's guest, Dr. Gary Bennett, has developed an Interactive Obesity Treatment Approach, or iOTA for short, that represents a real advance in this area. Dr. Bennett is Professor of Psychology and Neuroscience, Medicine and Global Health at Duke University, where he is also Dean of Trinity College of Arts and Sciences.

Interview Summary

You know, in this time when people are talking about more expensive, and kind of more intrusive interventions, like the big weight loss drugs, it's nice to know that there may be alternatives that could be accessible to more people. Could we start off with you telling our listeners what the iOTA approach is and how it works?

Sure. This is an approach for weight management. It's useful for weight loss or preventing weight gain or maintaining one's weight after you've lost weight. The idea here is that it's a technology that's designed to be highly accessible, and useful for a range of different types of populations. So, as you described, we have developed and tested this primarily for folks who are medically vulnerable, who are low income, who are racial, ethnic minority, who live in rural communities, and where we have traditionally had real difficulty reaching populations with effective weight loss tools. So, iOTA is a fully digital approach. It uses technologies smartphone apps, but it can also use text messaging, interactive voice response, those are like robocalls, automated telephone calls, websites. We've tested this on a wide range of different types of technology platforms, and we've tested it in a range of different types of populations all over the country and indeed even in other countries.

So, give us some examples of what kind of information people might be receiving through these various forms of media.

The underlying kind of technology, the underlying approach, I should say, for iOTA is actually reasonably simple. It operates from the perspective that creating weight loss is really about making an energy deficit. That is to say, helping people to consume fewer calories than they are expending. The realization we had years ago is that you can get there, you can create that calorie deficit in a whole host of different ways. Some people diet, some people try to get more active, there are limitations around that kind of approach. But fundamentally, you can also just get there by asking people to do some reasonably straightforward behaviors. Like not consuming sugary beverages, or consuming fewer chips, cookies and candies. Or changing the amount of red meat that they put on the plate. And, if you frame those things out as goals, then you can prescribe those goals to people in ways that make sense to them personally. The trick though is actually in the idea of personalizing those goals to the given individual. And that's where technology comes in and gets very helpful. The case is, if you have a large library of these goals, you'd want to try to provide these in a highly personalized way. That really are aligned with what people's needs are and noting that those needs may change over time. So, what we do with iOTA is deliver a very short survey. That survey then helps us to be able to look into our library of goals and pick the ones that are most useful for our users. We prescribe those goals, and then we ask folks to self-monitor those goals. Self-monitoring or tracking is an extraordinarily powerful part of behavior change science. And so, we ask them to track using one of our technologies: the chat bot or the text message or interactive voice response or the smartphone app. Every time that we receive data from one of our users, we give them highly personalized feedback that is designed around principles of behavior change science. And then over time we also give them support. We do support sometimes from a coach or sometimes from a layperson, sometimes it's even from a physician. And over time what we find is that this kind of an iOTA approach helps people to lose weight, prevent weight gain, have weight loss maintenance, but it also has a cascade of other types of effects, some of which we didn't really even anticipate producing.

This reminds me of something that I've fought for years, that nutrition and weight control can get incredibly complicated and down on the weeds in a fascinating way from a academic point of view. But that you can get to the goal line with just a few simple things. You might be 80% to the goal line just by eating less junk food and eating more fruits and vegetables and getting mired in that last 20% becomes confusing. It sounds like that's exactly what you're doing. That you kind of picked some of the big things that people can do, establish goals around them, and then provide a behavioral path for getting to those goals.

That's precisely our thinking. And the thing I'd add to that is part of the challenge in weight control is making those types of changes for long amount period of time that it takes to produce and sustain weight losses. One of the things we know is that any kind of behavior change, but particularly behavior change for weight control purposes just requires an extraordinary amount of engagement over a very, very long time. So, I'm fond of saying to our teams and to others I'm really much less concerned with strategies that produce weight changes at a month or two months. Because the real question for us is how do we create technologies that can support users as they enter the 10th month or the 12th month? Fundamentally, what we're really after here. It's not really weight loss, but it's really the changes in a whole range of health parameters. So cardiometabolic function, the indicators of the development of various cancers, diabetes parameters, those kinds of things. And it takes time and effort to produce those changes via the weight control, changes that we're hoping to produce with these technologies.

What kind of results are you getting from this and does the iOTA program in fact make it easier for people to stay on track with their health goals?

Yes, it's a really interesting set of findings over more than a half dozen trials in the last bunch of years. If I were to summarize, I'd say we get pretty modest weight losses relative to say, what you might get with a very intensive weight loss intervention or with a drug or certainly with surgery. But what's different is that those weight changes do tend to be sustained over time. So, they're modest, but they last. And the really interesting finding for us is that people stay very engaged with these technologies. On average, people tend to use new apps pretty feverishly in the first month after they downloaded, or they put it on their phone one way or another. And then most people, about 70% of the time, people move away from those apps, they disengage. When we look back about a year after people started using iOTA, it's very, very common for people to be engaged with our technologies 80-85% of the time. That is to say, they're still tracking their goals at about 80% fidelity after a year. That's really terrific. and it's one of the reasons I think that we're able to see sustained losses, even though those losses aren't very large. And again, my goal here is much less - this is a public health approach - I'm much less interested here in trying to produce large weight losses for cosmetic reasons and those kinds of things. This is really an effort to try to create a very highly disseminatable, inexpensive treatment that is accessible to large numbers of folks. In trials, we certainly have seen changes in blood pressure and various cardiometabolic parameters like lipids. Those changes tend to be larger in certain populations. When we tested this in China, we saw very, very large dips in lipids. And those too also do tend to be sustained. The biggest surprise for us over the years has been a relatively consistent set of findings that suggest that people have improved wellbeing on the backend of participating in one of these kinds of treatments. They tend to feel less stressed, have more energy, and have better quality of life. In fact, we've seen very, very large reductions in depressive symptoms in study after study. I'll just add tangentially that's notable for us in the populations in which we work, because these are not populations for whom weight is very closely tied with one's emotional state. That is to say, the patient populations in which we work tend to have more tolerance for heavier body weights compared to other populations. So, when we see weight loss in our trials, we don't often expect to see that accompanied by improvements in depressive symptoms. But we see it in study after study after study. So, we've been really pleased with this broad array of impacts that this technology seems to produce.

It's nice to hear the positive results. And I also like your aspirations because a smaller weight loss, better maintained is a much better outcome than a larger weight loss regain, which is typically the case. And the fact that you're getting these corollary effects in other areas of life, like mental health and things like that is very impressive. Are there other stories you could tell from people that have been on the program that might be illustrative?

Oh yes. What happens most often in our studies is that at some point one of our patients approaches me and says, "You know, I've tried everything. I've tried dieting, tried this app and that app and this is just so easy. I've been able to stick with it for a long time." That happens a lot. And it always, always pleases me greatly because at the end of the day we're really trying to create these technologies for real people to use over a very, very long period of time. I find that exciting. We've had a number of people over the years who have gotten off their hypertension medications or have had seen changes in their diabetes, their A1Cs as a measure of diabetes. And it's just really exciting because then it's one of the things that I think gets us up in the mornings to do this work.

That is exciting. How has it been especially influential among people who otherwise have limited access to care?

We really started this work because of a series of observations that I made early in my career when I started working in community health centers. Community health centers are often primary care units in many major metropolitan areas, and often in rural settings as well. Their primary intention is to serve patients who are medically vulnerable, and often patients who are poor. On those settings, the providers in those settings are just doing extraordinary work. And I started to spend time there and was trying to understand how we might think about situating this kind of technology and these kinds of public health style interventions within those care settings. And the observation I made over and over and over again was that, even in these care settings that are really designed to serve patients who have low income or come from limited income backgrounds, weight control and behavior change in general was just not the highest priority. These physicians are dealing with all manner of acute and chronic health crises. And they just didn't feel that managing a patient's weight was the best use of their limited clinical time and attention with patients. The challenge of that, of course, is that, for patients who have obesity, that can be a primary cause of many of the acute and chronic conditions that my physician colleagues were treating. And so what I began to observe was that patients who have the greatest need for comprehensive obesity care are often the least likely to receive it. And this is borne out by national data, which suggests that if you're a person from a medically vulnerable background and you have obesity, you're dramatically less likely to receive high quality care from the health system. And then there are a whole range of financial constraints that limit your ability to be able to acquire that care in the commercial market. And so there are really many, many people, really, tens of millions of folks out there without options. So, that's really why we started developing these tools. And I'm very pleased to say that the underlying approach that we develop with iOTA has been leveraged in a variety of weight control interventions that are being used in other places. The next frontier for us is to really think about how to disseminate this in a more widely accessible way. We've begun having conversations with metropolitan areas. Cities where health departments are thinking about doing these kinds of things. Some of these technologies have found their way into other systems. And increasingly as we have begun to test these approaches in clinical care settings, we certainly have seen ongoing use of these technologies in the community health centers where we originally came up with some of these ideas. So, much more work there to be done but I'm hopeful.

Do you see a role for this approach in conjunction with or as a companion to the weight loss medications that are getting so much attention now?

Yes, I do. One of the things that's notable about this generation of weight loss medications is that they do not have an indication that they should be accompanied with a behavior change intervention. So, the other way to say that is that most weight loss drugs that we've seen in years past have received FDA approval, contingent on their combination, their use, alongside a behavior change intervention. And the GLPs, the ones that are most recently emerged, don't have that indication. Nevertheless, we know a couple of things. One is that these are medications that are designed to be used for very long time in order for fat, weight loss to be sustained. And there are a number of people who increasingly are interested in transitioning off of these medications and beginning to engage weight control on their own. So, my sense is that technologies like iOTA can be very useful in helping people make those transitions off of drug. I think the technologies we've created can be very, very useful as an adjunct to try to help to maintain motivation for weight loss. And to think about addressing some of the related behaviors that can help people to experience an overall improvement in their health. So, becoming more physically active and making changes in stress and wellbeing as an adjunct to the weight loss that's being produced by the drugs. I have to tell you, I'm very, very concerned about the cost of these medications. I'm very pleased by their efficacy, but I'm extraordinarily concerned about their cost and their limited accessibility. I expect that will change. But during this period of time, I'm very concerned about the creation of additional disparities, patient's ability to seek really high-quality care.

I'm glad you raised that point. So, where do you see the work going next with IOTA?

Well, I see it going in two directions. One, we are thinking about dissemination. Where can you embed this kind of approach inexpensively in ways that allow the greatest number of users. The emergence of artificial intelligence technologies, notably the large language models, really help in that regard because they allow us to deliver that kind of core iOTA special sauce more flexibly in a range of different technologies. And even more inexpensively than we can do right now. iOTA is extremely cost effective and with AI delivery it could be even more so. And then the other path I see is really what you asked before. And it's how do we think about using these technologies as an adjunct to medication treatment, which I think will become even more common over the next couple of years. I hope that it becomes a more common approach that's used to treat the patients who have the highest risk of obesity and all of the chronic health conditions that travel along with it.

Bio

Gary Bennett, a professor in the department of Psychology & Neuroscience who also holds appointments in Global Health, Medicine and Nursing, is the founding director of the Duke Digital Health Science Center. For 20 years, he has been studying how incorporating digital strategies into clinical treatment of obesity can improve health outcomes. His development of the Interactive Obesity Treatment Approach (iOTA) has been supported by over $20 million in grants from the National Institutes of Health.

In today's podcast, we're discussing Fast and Furious. But it's not the movie series starring Vin Diesel. Instead, the catchphrase describes rapidly increasing and somewhat confusing food system environmental impact reporting. Food firms, farmers, and governments all have a clear need for more quantitative environmental impact data in order to measure and understand factors such as carbon footprint, sustainable agricultural practices, and food supply chain processes. But there is no single standard for such reporting and different measurement methodologies make it difficult to assess progress. What's more, greater transparency regarding environmental impacts and food systems will affect trade and supply chains. Our guest today is Koen Deconinck from the Trade and Agricultural Directorate of the Organization for Economic Cooperation and Development, or OECD for short.

Interview Summary

You and your colleagues at the OECD recently published a paper called Fast and Furious: The Rise of Environmental Impact Reporting in Food Systems. Can you tell me a little bit about the paper?

Sure. A while ago we were talking to one of the world's experts on sustainability in food systems. He alerted us that there was a major change happening in how people think about sustainability in food systems. He told us in the past, it was thought of almost as a checklist, right? People would say, here's a list of practices that you should or shouldn't use. And then we'll come and confirm whether that's the case on your farm. Then you either get certified or you don't. And he said, you should pay attention because there's a big change underway. We're more and more moving towards actually quantifying things like what is your carbon footprint? What is your water footprint? And so on. He convinced us that this was actually a major change that was happening. Oddly enough, outside of the role of the practitioners, not that many people have been paying attention to it. That is why we wrote this paper.

This is a really important shift because just thinking about this in terms of economics, evaluating outputs versus the methods that you get to those outputs can have really significant implications for the various actors involved. So, this seems like a good move, but it seems also kind of complicated. I would love to hear your thoughts about that particular move. Why did you think, or why did you all realize this was a challenge and opportunity at the same?

That's a great question. It actually gets to the heart of what we're describing in the paper. Starting with the good news, we do think that this has an enormous potential to improve sustainability in food systems. Because we know from the scientific evidence that there are big differences between different kinds of food products in terms of their average environmental impact.

For example, beef tends to have more greenhouse gas emissions per kilogram of products relative to poultry and then definitely relative to plant based alternatives and so on. You can see these kinds of average differences. But then the data also shows that within each kind of product category, there's huge differences between different farmers.

And what you can do if you start quantifying those footprints is it actually unlocks different kinds of levers. The first lever, if you think about carbon footprints, which is maybe the most intuitive example. The first lever is people know the carbon footprint of different kinds of food products. They could shift their diets away from the products that have a higher footprint towards products that have a lower footprint. For example, less beef and more towards poultry or towards plant-based alternatives. That's one lever.

A second lever is that if you can also start to get even more precise and use data that is specific to each producer, not just an average, then also within each product category, people can start shifting towards the producers that have a lower environmental footprint. So, for example, people will still be drinking milk, but then they can shift towards milk producers that have a lower carbon footprint. And the third interesting lever that you can unlock is if you have that data at a supplier level. Suppliers could then say, well, I changed my practices. I changed my inputs. I've done things differently to reduce my impact. You actually can stimulate innovation by each individual farmer, each individual company in the supply chain to lower that impact. And that is something that you can do if you're quantifying those impacts, and that is very difficult or even impossible to do with this previous checklist-based approach. So that's one of the reasons why we're, we think that this has tremendous potential if we get it right.

That's right. Just saying that you're doing sustainable practices isn't sufficient. It's really critical to evaluate what kinds of greenhouse gas emissions or other environmentally problematic outcomes of that producer or firm is what really matters. But I have to ask you just how difficult, how realistic is it to be able to measure the environmental impact of every farm?

That's a really good question. And of course, if you think about agriculture compared to other sectors, one of the big challenges for agriculture is indeed that there's just so many producers, right? I talked to people who work in the steel industry, and they say that their industry is complicated, but there's basically only 1000 steel factories around the world. That's not that many. The latest evidence suggests that there's more than 600 million farmers worldwide. So clearly, we're talking about a completely different order of magnitude, order of complexity.

And the second difficulty is that when we talk about measurements, for a steel factory, in theory, you could put sensors in the chimney and sort of measure that. For agriculture, that's really not practical. Scientists would sometimes do that because, you know, otherwise it's hard to know what greenhouse gas emissions you have in agriculture. But it's clearly not something that you're going to do on 600 million farms.

So, what people do instead is, scientists would do the primary research. There are different ways of doing that, to try and estimate which kinds of practices have which kinds of environmental impacts. If you have a cow and it has this kind of diet, how much methane is it burping and how is it affected by differences in the kinds of feed that you give the animal and whether it's inside or outside and so on. And then based on that very detailed research, that then gets simplified into a simpler model, a simpler tool, so that the farmer can plug in some key performance indicators from their farm. I can say ‘I have these many cows, this is the feed rations that I'm giving to them. These are the kinds of manure management options that I have.’ And then that tool is a simplified tool that basically gives you an estimate of those emissions. And once you have a tool like that, of course, the challenge is already a lot easier. Because then, if your tool is user friendly and you can sort of focus on just a couple of key parameters that farmers would know, then, of course, you can scale it up. And there are actual examples like that. In Ireland, there is a scheme called Origin Green, which is an initiative by the Irish government to promote exports of Irish Agri food products. They cover something like 90 percent of all the beef and dairy farms in the country. And as part of the initiative, they do the audits anyway, but as part of that initiative, they also quantify the carbon footprint. They basically have farm level data for 90 percent of the farmers. New Zealand similarly has had a big campaign called Know Your Numbers, where they've convinced farmers to use these kinds of calculation tools to get a good insight on how much the emissions are on their farm.

So, it is definitely not straightforward. But at the same time, we do see that it is actually happening. It is actually feasible.

Thank you for sharing that. This is really impressive work that's happening in the European context and in New Zealand. I have to ask, how challenging is this for small or medium sized producers? I mean, both in a European or Northern context, but particularly when we start thinking about the fact that Agri food chains are global and, and so there can be production practices in the Southern countries that would be of concern. How do you think about this in this context?

It is a really important issue. And actually, we've been here before. If you go back something like 20 years ago, and I think you actually did some research on this yourself back in the days, Norbert. There was a big increase in food safety standards, food quality standards. And these were not necessarily public standards. It was quite often retailers who started to impose that on their suppliers. And we did have all those concerns, right? Because on the one hand, it was making food safer and higher quality for consumers. But on the other hand, there was this risk that it would actually exclude, especially the poor producers, the small and medium sized enterprises from those supply chains. There's been a lot of research about that and it turns out that in the end, it was more nuanced than what people feared initially. But of course, we definitely have the same concern now. And there's a few elements to it. One is simply the difficulty of actually quantifying those things. I mentioned a few of these calculation tools and a few of these initiatives. So far, most of the investment in these things has been in high income countries. And even if you look at the underlying science, most of the research has happened in richer countries. So, if you go to tropical agriculture, we even have less scientific evidence that you would use to build a simplified tool like that. Then there's, of course, the challenge of actually getting farmers to use that. So, governments in developing countries typically don't have the same kind of capacity that the government of New Zealand, or the government of Ireland has to help farmers do that. So, there's definitely a role there for development cooperation, technical assistance, things like that.

But there's also another concern, which is that one of the important drivers of the environmental impacts of food products is actually your productivity. There are many parts of the food system where your environmental impacts might be roughly the same, no matter whether you are actually very productive or not. So, if you have the type of variety of rice or wheat that you're using that just has relatively low yields, then, of course, you divide the total environmental impact by a smaller number. So, automatically, your relative impact is bigger. And typically, that is what we find in the Global South. So, typically, the producers there will have much lower productivity levels. And studies do find that they tend to have higher environmental impacts, all else equal. So even if they were able to quantify it, there is actually an additional risk that then they would still get excluded.

What that means is that this rise of quantified environmental impact reporting is something that we need to pay close attention to. And development corporation agencies and everybody else should be thinking hard about how we are going to make sure that producers in the Global South are not only able to quantify, but also able to improve those environmental impacts. For example, through sustainable productivity growth.

This is really helpful. And thank you for sharing that. And you're right. I did think about these issues. I was influenced rather by the experience of increasing food safety standards. I would say one of the differences that we saw with food safety standards was how safe can food be? I mean, we want our food to be extremely safe, but there are always these tradeoffs. With environmental impacts, I think it feels a little different. And I really appreciate the concern of the difference between these small and medium sized enterprises, particularly out of a developing country context. I've got to ask sort of a broader question. Why is all of this happening now? This increase of environmental sustainability measures, both in terms of the technical work and the demand. I mean, what's bringing all of this together?

It is actually a pretty interesting story because it appears that, the way we look at it, there's been some changes on the demand side and on the supply side, so to speak, right? So, there's this growing demand for more information. Consumers are increasingly conscious about these things, even though it's not clear yet if this really translates into their shopping behavior. Civil society organizations, of course, have long been asking for more information on that. Governments, in some cases, are also pushing for that. One clear example there is in the European Union. There is this new rule in the EU. It's called the Corporate Sustainability Reporting Directive. That's quite a mouthful. And one of the things it does is it requires all large companies to report not only their own emissions and the emissions from the energy that they're purchasing, but also their emissions upstream and downstream in their supply chain. People sometimes call this Scope Three Emissions. This has huge ramifications because it means that for the supermarkets, a large part of their Scope Three Emissions are the emissions from food. They would then probably ask the food manufacturers 'well, give us more information on your carbon footprints.' And in turn, for the food manufacturers, a large part of their carbon footprint comes upstream from the agricultural sector. So, everybody would be turning around and asking their supplier and all the way up the supply chain for more information. All the way, not only to the farmer, but even further up to the fertilizer companies and so on.

So, there's definitely this push on the demand side. And, I guess governments and citizens and civil society, those are sort of the usual suspects, so to speak. There's also unexpectedly a lot of pressure from investors. We see organizations of investors pushing hard for more transparency. Their logic is that sooner or later, stricter regulations on the environmental side are going to come. For some of the companies that we're currently investing in, we have no idea how hard that would hit them. So, those companies need to disclose more information because we as investors need to know how much money is at risk if we invest in a business that is, for example, linked to deforestation and things like that.

So, that's the demand side. But what is really interesting is that at the same time on the supply side, it's also becoming easier to actually provide that information compared to five or 10 years ago. Some of this is because people have been working in obscurity for a long time, trying to develop certain methods and databases. A lot of that work has been coming to fruition in just the last few years. For example, there's been development of new reporting standards, there's been development of new databases, there's been development of new methods, people are now using satellites and so on to try and quantify things like land use change, deforestation impacts and so on. A lot of these things are now converging and blending with each other. We do think that the combination of this greater demand and greater supply that is driving what we're seeing now. And of course, some of these initiatives are still at a relatively early stage. At the same time, I think the direction of travel is clear. So, we think that demand is not going to go down. It will keep getting easier to supply that information. We think that this is what explains this fast increase that we're seeing.

This is really intriguing, and it makes me wonder how global value chains are going to be realigned. Going back to this idea of small and medium sized producers who may not be able to have the monitoring, or if you think of even larger firms who feel uncomfortable with having some outside agency evaluating the carbon emissions or other greenhouse gas emissions from their farm. I can imagine that this could realign value chains. Is this a fair assessment? Is this a concern?

I agree with you that this is something people should be looking at. At the moment, there's not yet any data on that. I don't think anybody has really researched that. We see in general that many researchers aren't really paying attention to this trend, which was actually one of the reasons we wrote this paper. But what you're describing is exactly one of the questions we have as well. There are a few ways that this could play out. You could imagine that if it's only some markets that are getting very interested in this kind of information, you might have a situation where companies in a producing country decide to just send the sustainable stuff to the countries that care about sustainability. But they keep producing the unsustainable stuff for all the other markets. In that case, the total impact for the environment might actually be limited. But there could also be other cases where companies think, well, since a large part of our customer base is asking for more sustainability, we might as well make everything sustainable just to be on the safe side. You might have other cases where companies start working backwards because they want to make sure that what they are selling is sustainable. So, you might actually have situations where a retailer starts working with suppliers or where a food manufacturer starts working with suppliers to make sure that their production is sustainable.

This is again something that we have seen in the wake of these food safety standards about 20 years ago. This was a really surprising development and there was a lot of investment from other companies in the supply chain to help farmers start meeting these stricter food safety standards. So, one possibility is that something like that might happen for environmental sustainability as well. At the moment, these are all really just hypotheses. And so I really hope people will start to investigate this more seriously, because I think it is very important also for policymakers to understand what has happened.

I'm really appreciative of you making the point that there is just a great deal of uncertainty in this space and that there is a need for researchers to explore this issue. And I agree the food safety concerns of 20 or so years ago is a good example. But I think there are going to be some differences and I'll be intrigued to see how that plays out. I am interested to understand, are there any risks besides the ones that we've kind of touched on, any other risks or downsides to this movement that we're seeing?

Yes, there are actually. Because the story I told so far was maybe a little bit on the optimistic side. I was explaining how it's becoming easier to supply the information in part because we now have better reporting standards. That is one part of the story. That's sort of the glass half full view of it.

The glass half empty view is that actually, at the same time, there's also a fragmentation. There are also many different initiatives, and this is why we call it fast and furious. So, there's lots of different initiatives that are competing for attention. And you do end up with situations where you might have different ways of calculating certain environmental impact. Different ways of reporting it. And then it's not necessarily clear when somebody is reporting something what exactly they were using as methods. And so that poses an enormous risk, because if every supermarket or every country starts coming up with its own way of doing things, its own way of reporting, then the end result is just going to be confusion and frustration and transaction costs. And then the benefits for the environment won't even be there.

So, it is really important if you want this to go well, that people get together, stakeholders, governments, researchers, to get together and try to align as much as possible on common reporting standards, common methodologies, etc. So that it's clear for everybody that the data that we're looking at is comparable. This is important, and I can imagine if we think about international accords on addressing climate change and how it takes a lot of effort to get agreement on those, you can imagine that when we're talking about these kinds of measures and getting concordance on that, there could be some real challenges.

We've already touched on this, but I'm interested to know, are there other policy implications of the work that this paper is doing? Is there something we should be paying attention to?

Well, one idea that I hope people would start taking seriously is I want people to start thinking in timelines and cycles. And let me explain what I mean by that. There's a lot of different initiatives out there. And you can even start to see a little bit of a hierarchy, how different things, some of these standards are building on other standards. Some of these databases are then in turn using some of those other standards. There's a kind of a logic that is emerging there. One of the problems that happens now is that it's not really clear when all of these elements are going to get updated. So, suddenly one of those standards might get updated and then now all of these other standards that build on that or those databases that build on that are suddenly no longer consistent with that original standard. And then there's some confusion and then it's not really clear whether the data you are using is actually still consistent with the original standard. One idea that I'm advocating for is that people should all explicitly define a certain iteration cycle where they say, look, every four years, for example, or every three years, every five years, we are going to review the standard. We'll give everybody 12 months of warning, and we'll have a stakeholder process, and we'll have a scientific process behind that so it's clear for everybody what we're changing and why. But this way, you know well in advance when each of these building blocks is going to get updated. Then that would make it a lot easier for everybody to make sure that what they're doing is aligned with those standards. And an additional benefit of doing it like that, I think, is these things are moving so fast and there's still so much new science and new technology coming in, that we have to keep the possibility open to keep improving and updating those methods and those standards as well. If you announce in advance that we'll do this on a three year cycle or a four year cycle or whatever it may be, I think that could help us strike a balance between the need for that flexibility, but at the same time that need for stability. Because of course, if things keep changing all the time, then you're never quite sure whether the numbers you're looking at make sense or can be compared. I think that idea would be very helpful. And that will probably require quite a bit of coordination between all the different stakeholders who work in that space. And I think that would be a very good thing to do.

BIO

Koen Deconinck is an economist in the Trade and Agriculture Directorate of the OECD (Organization for Economic Co-operation and Development) in Paris. He was lead author of the OECD report “Making Better Policies for Food Systems” (2021) and has worked on market concentration, seed markets, evidence gaps, resilience, and environmental impacts of food systems. He holds a PhD in Economics from the University of Leuven and has published research in the American Journal of Agricultural Economics, the European Review of Agricultural Economics, Food Policy, and Business History, among others. He currently works on measurement of carbon footprints and other environmental impacts of food.

Fast food is part of American life. As much a part of our background as the sky and the clouds. But it wasn't always that way, and over the decades, the fast food landscape has changed in quite profound ways. Race is a key part of that picture. A landmark exploration of this has been published by today's guest, Dr. Naa Oyo Kwate. She is an Associate Professor in the Department of Africana Studies and the Department of Human Ecology at Rutgers University. Her book, recently published, is entitled White Burgers, Black Cash: Fast Food From Black Exclusion to Exploitation. The book has been received very positively by the field. And was recently named the best book in the field of urban affairs by the Urban Affairs Association.

Interview Summary

I was so happy to see your book because people have talked about the issue of race off and on in the field, but to see this kind of scholarly treatment of it like you provided has been really a welcome addition. Let me start with a general question. Let's begin with the fast food situation today and then rewind to where it began. Are there patterns to where fast food restaurants are located and who fast food is marketed to?

Absolutely. There's quite a bit of research, and you just alluded to the work that's been done in the field. There's a lot of research that shows fast food is most dense in African American communities. Not every study has the same finding, but overall that's what the accumulated evidence shows. On the one hand you have the fact that Black communities are disproportionately saturated with these outlets. Then there's also the case that apart from the physical locations of the restaurants, fast food is strongly racialized as Black in terms of how it's portrayed to the public. It [Fast Food] relies on images of Blackness and Black cultural productions such as Black music for its marketing. These sometimes these veer into racial caricature as well. One of the things I talked about in the book briefly is the TV commercial character Annie who Popeye's introduced in 2009. They basically created this Black woman that Adweek at the time was calling "feisty," but it's really just this stereotypical idea of the sassy Black woman and she's in the kitchen frying up the chicken for Popeye's. And actually, some of the language that was used in those commercials really evokes the copy on late 19th century and Aunt Jemima pancake mix packaging. It's a really strong departure from fast food's early days, the way that fast food is now relying on Blackness as part of its core marketing constructs.

I'm assuming that it follows from what you've been saying that the African American community has disproportionately been targeted with the marketing of these foods. Is that true of children within that community?

Research shows that in terms of fast food marketing at the point of purchase. There's more - display advertising for example at restaurants that are in Black communities. And then there's also been research to show, not in terms of the outlets themselves, but in terms of TV programming that there tends to be more commercials for fast food and other unhealthy foods during shows that are targeting Black youth.

How much of the patterning of the fast food restaurants is due to income or due to the amount of fast food consumption in these areas with many restaurants?

Almost none of it really. It's not income and it's not the amount of fast food that people are consuming. In fact, one of the main studies that led me to start researching this book, because I was coming to it from public health where there was a lot of research around the disproportionality of fast food restaurants. We actually did a study in New York City, some colleagues and we published it in 2009, where we looked at how fast food was distributed across New York City's five boroughs. And restaurant density, we found, was due almost entirely to racial demographics. There's very little contribution from income. So, the percentage of Black residents was what was driving it. That was the biggest predictor of where fast food was located. It wasn't income, income made very little contribution and if you compared Black neighborhoods that were higher in income to those that were lower in income, they basically had about as much fast food exposure. Then if you compare them to white neighborhoods matched in income, Black neighborhoods still had more. So, it wasn't income, it was race. There are other areas that were high in fast food density like Midtown and downtown Manhattan where you have commercial and business districts, transportation hubs, tourist destinations. So, you expect fast food to be in these really dense and kind of busy commercial areas, but the only residential space that had comparable density were Black and brown neighborhoods. The assumption that many people have is that, okay, well if it's not income, then it's probably demand. So probably fast food is just dense in those neighborhoods because Black people eat so much fast food. But again, the data do not bear that out, not just in our study, but in others. And in fact, apart from the study we did specifically on fast food, we did another study where we looked at retail redlining for a number of different kinds of retail sectors. And again, demand is not what situates, you know, where stores are or are not. And then when I got to this project, just digging through the archives, you find that until the industry really went in on targeted advertising to increase the numbers of visits that Black people were making to fast food restaurants and the average check size that they were spending, Black consumers were mostly using fast food as a quick snack, it wasn't a primary place for meals. So it's really the case that the restaurants proceeded the demand and not the inverse.

It is an absolutely fascinating picture. My guess is that what you've just said will probably come as a surprise to some people who are listening to this, not that fast food isn't dense in particular neighborhoods, but that it's particularly dense in neighborhoods by race just because people generally think that fast food is popular everywhere. So, let's talk about why this occurred and dive a little more deeply into what your book does and that's to provide a historical view on how and why this evolved. So, what did the early history look like and then what happened?

So, the book traces what's basically a national story, but I focus particularly on certain cities like Chicago, New York and DC. But it's tracing how fast food changed racially and spatially from the early 1900's to the present. I break out that early history into what I call first and second-generation chains. So, they opened in urban and suburban areas respectively. The birth of the first generation fast food restaurants took place in what is termed the Nader of race relations in the US from the end of the Civil War to the 1930s. So, this is a time during which you see Plessy versus Ferguson, for example, ushering in legal segregation. Lynchings are at their worst. You have the destruction of Greenwood in Tulsa, Oklahoma. That's taking place and other notable incidents and forces that were undermining Black life at the time. It's during that context that the first generation restaurants are born. And so, these are burger chains like White Castle, that was the first actually big burger chain. People often assume it's McDonald's, but it's actually White Castle in 1921. And then there are knockoffs of White Castle, like White Tower and Little Tavern, which was an East coast brand. And then there were also other restaurants that were not burger chains, but more like hot shops was more of a sit-down restaurant. And then you had Horn and Hardart, the outlets where they had auto mats. So, you know, this was kind of high tech at the time, but you would go in and the food was behind little glass compartments and you would put in your requisite number of nickels and then take out your little plate of food. These were all the restaurants that I'm calling first generation restaurants. So, you had quite a bit of diversity in terms of what they were serving, but they were all in urban centers. They were not franchised. They were corporate owned outlets and most importantly everything about them was white, whether figuratively in terms of who dined and worked there or literally in the architecture and the design and the name like White Castle. That veneer of whiteness was doing two things. On the one hand, trying to offer the promise of pristine sanitary conditions because this is a time when food production was rife with concerns. And then also it's trying to promise a kind of unsullied social whiteness in the dining experience. So, first generation then leads to second generation fast food, which begins in the suburbs instead of the urban centers. Second generation fast food starts to grow in the early 1950s. These are the brand names that are most synonymous with fast food today: KFC, Burger King, McDonald's. So, for example, Ray Crock launches McDonald's as a franchise in the all white suburb of Des Plaines outside Chicago near O'Hare airport. And he set to fly over prospective sites looking for church steeples and schools, which to him were an indication of a middle class and stable community, but of course, racializing that as white. Because you could have Black neighborhoods with church steeples, but that was not where the restaurants were going. So, what ends up happening with second generation fast food is that it takes this theme of purity and shifts so that it's not just the purity of simple kind of fuel for the working man, but instead the purity of white domestic space. And where first-generation restaurants targeted working adults, the second went after families and children. Fast food then becomes more than just food - it's about fun. Those are the two key ways to think about the early history.

One could obviously find many, many, many examples of different racial groups being excluded from the economic mainstream of the country. For example, areas of employment, and my guess is that being excluded from the marketing applied to consumer goods and lots of other things. But do you think there's something special about food in this context?

Oh, that's a good question. It's interesting because fast food. It's food, but it's more than that the way that fast food initially excluded Black people. One of the things I talk about in the early part of the book is James Baldwin going to a restaurant and trying to order a burger and being rejected and facing discrimination. And the idea that it's not just that you can't get a burger, it's not the same thing as if you try to buy, I don't know, a ham sandwich or something. But like what burger means something more than that, right? It's bigger than a burger is Ella Baker said. Fast food is kind of like the closest thing we have to a national meal. It sort of occupies a special place in the heart of America and is symbolic of this quintessential all-American meal. And the notions of a good and simple life that we purportedly have in this country. So, it means more I think the way that fast food was positioned as something that was totally wrapped up in this exclusionary whiteness.

Your book traces the long pathway that fast food traveled going from exclusion in the beginning and then later exploitation. Can you describe a couple of the key turning points?

Well I would say that it wasn't like a light sort of got switched on that caused fast food to shift abruptly from utterly excluding Black people to then pursuing them full throttle the next day. It was quite a long and bumpy pathway and really American retailers in general have continually had to discover Black consumers and the fact that they exist over and over. And then sort of trying to think like, oh, how do we reach them? We don't understand them, like they're this enigma kind of thing. Fast food was doing the same kind of thing. There was both what the industry was doing and then there were also pull factors that were causing fast food to be drawn into Black communities as well. There are a lot of turning points, but I would say if you start fairly early in the history, a key one was after second generation fast food got going. Where suburban fast food right, is trying to position itself as this white utopia. But almost immediately that notion was fraught and unstable because concerns quickly arose around teenagers. They were money makers but they were also rowdy. Their behavior, hot rodding and goofing off in the parking lot and so on, was off-putting to the adult diners. So, it became this difficult kind of needle to thread of like how are we going to track this consumer segment that's foundational to the enterprise but do so under conditions that would keep them in line and not mess up the other potential revenue that we have going. As the kind of nuisance of fast foods became more pitched, municipalities began introducing ordinances to control fast food or even ban it. And that made the suburbs harder to get into or to maintain a foothold in. Corporations then start looking more at the cities that they were avoiding in the first place and the Black communities there that they had excluded. So that happens fairly early and then some other key turning points occur throughout the 1960s. Here we have urban renewal, you have urban rebellions taking place and during the late 1960s when these rebellions and uprisings were taking place, this is the time period when you get the first Black franchisees. Into the 1970s you have oil crises, then you have the burger and chicken wars as the industry called them in the 1980s. And this was referring to corporations battling each other for market share. So, all throughout the history there were different turning points that either accelerated the proliferation of fast food or sort of change the way the industry was looking at Black consumers and so on.

Now in some discussions I've heard of this issue off and on over the years from people who have looked at the issue of targeted marketing who have talked about how there was a period of time and you made this clear, when Blacks were excluded from the marketing and they just weren't part of the overall picture of these restaurants. Then there was a movement for Blacks to be included more in the mainstream of American culture so that it was almost seen as an advance when they became included in the marketing. Black individuals were shown in the marketing and part of the iconic part of these restaurants. So that was seen as somewhat of a victory. What do you think of that?

It's true and not true. I mean when fast food decided to finally start actually representing Black people in its marketing, I think that is important. I do think that the fact that they were finally making ads and conceiving of campaigns that saw Black people as part of the actual consumer base at which they were, yes, that that is important. But it's also the case that corporations are never doing anything for altruism. It's because they wanted to shore up their bottom line. So, for example, Burrell Advertising is the biggest African American ad shop based in Chicago. They get the McDonald's account and so they're the first ones to have a fast food restaurant account. They begin their campaign in 1971 and at that time, their advertising actually positioned Black families as regular people doing everything everybody else does and going to the restaurant and enjoying time together as a family and so on. And I think those kinds of images were important that they were creating them, but again, at the same time it was only the context in which Burrell got that account. The reasons why McDonald's was reaching out to Black consumers was because, again, in the early 1970s white suburbs were becoming more saturated, and McDonald's needing to expand. Then you have the oil crisis in which people are not driving as much, and Black people because of racism are centered in urban centers and not in the suburbs. So that makes a logical place for them to go and so on. So, it's not without its vexed context that those new advertising images and opportunities were taking place.

Okay, thanks. I know that's a complicated topic, so I appreciate you addressing that. You know, something you mentioned just a few moments ago was that when Blacks started to become owners of franchises, can you expand on that a little bit and say what was the significance?

Yes. First of all, cities were changing at that time. White residents were moving to the suburbs, multiple public and private policies were keeping the suburbs white and white residents were moving to white suburbs. So, Central City was changing, right? The neighborhoods that had been white before were now changing to become predominantly Black. And so, the fast food outlets that were located in those neighborhoods found their client base changing around them. And many of those operators, and indeed their corporate superiors, were uninterested in and uninformed about a Black consumer base at best and outwardly hostile at worst. You end up with as neighborhood racial transitions are taking place, white operators are now in communities they never meant to serve. Som as urban uprisings rack one city after another, Black franchisees are brought on kind of as a public face in these changing urban areas. The primary goal was to really have Black franchisees manage the racial risks that corporate was finding untenable. They realized that it wouldn't do to have white managers or franchise owners in these neighborhoods. So, they bring in Black franchisees to start making that transition. And then after fast food becomes more interested in trying to deliberately capture more Black spending, Black franchisees become even more important in that regard. For their part, the Black franchisees were seeking out fast food outlets as a financial instrument, right? This was a way to contest and break down unfair and pervasive exclusion from the country's resources. So, it was never about how much fast food we can possibly eat, right? Again, with the demand issue. So, Black franchisees are basically trying to get their part of the pie and then the federal government is heavily involved at this point because they start creating these different minority enterprise initiatives to grow Black small business. And so, it wasn't only the Black franchisees, but also Black franchisors who were starting their own chains. So, for example, former NFL Player Brady Keys started All Pro Chicken, as just one example. So, this idea of expanding fast food franchising to Black entrepreneurs who had been shut out on its face, seems like a laudable initiative. But again, it's like this is not just altruism and also the way that franchises were positioned in this kind of like you can get into business and do so in a way that's low risk because you know you don't have to start from scratch. You're buying into a thriving concern with name recognition and corporate support and all that. And all of that sounds good except you realize that in fact the franchisees are the ones who have to bear all the risk, not corporate. That's what the government was doing in terms of trying to put in all this money into franchising is really. It's like that's the response to the real life and death failures, for example, around policing, which was always at the heart of these uprisings. You have these real life and death concerns and then the government's responding with giving people access to fried chicken and burger outlets, which nobody was asking for really. Not only was the method problematic, but the execution as well. Just because Black people had more access to the franchises doesn't mean that the rest of the racism that was present, suddenly disappeared, right? The theoretical safety of a franchise didn't bear out in practice. Because of course they still couldn't get access to credit from lending institutions to launch their restaurants because they still didn't get support they needed from corporate, which in fact there are still lawsuits to this day by Black franchisees because the communities in which they're operating were still contending with deep inequality. All of that meant that that whole project was not likely to work very well. And you know, it's no surprise that it didn't.

You mentioned chicken several times. In fact, there's a chapter in your book entitled Criminal Chickens. Can you tell us more?

Yes, Criminal chicken is towards the end of the book. So, the book is organized in three parts. Part one is white utopias, part two is racial turnover, and part three is Black catastrophe. In each of those you see how Blackness is problematic, but in different ways. So Criminal Chicken is really dealing with the fact that by the 1990s, fast food had become pervasive in Black space and was thoroughly racialized as Black. And so, since fast food has saturated these neighborhoods, of course Black residents began to consume it more. With that, a program reigns down from the dominant society over Black people's alleged failure to control themselves and an assumed deviant predilection for unhealthy dietary behaviors, whether fast food, but also the same kind of discourse circulated around soul food. And the tenor of the discourse really raises W.E.B. DuBois's age-old question, which is how does it feel to be a problem? That was really the tenor of the conversation around fast food at that time. The chapters about the ways in which Black people's consumption was frequently characterized as deviant and interrogating the paradoxes around the symbolic meanings of fast food. Because like what we talked about earlier, Black people are basically being criticized for eating something that's supposedly at the heart of Americana. It's a kind of a no-win situation. On the one hand, certainly overseas, fast food continues to enjoy this kind of iconic status of America and American Burger and so on. Even within the country's borders it still retains some of that allure as something emblematic of American culture. But it's also now more fraught because, you know, we're in a moment where local and organic foods and so on are held in high esteem and fast food is the antithesis of that and it's industrial and mass produced and homogenized and has all these nutritional liabilities. So, basically, it's looking at the changing ideas around fast food and race and how that intersected with Black consumption.

That's so interesting. I'd like to wrap up with a question, but I'd like to lead into that by reading two quotes from your book that I think are especially interesting. Here's the first. It is painfully logical that Black communities would first be excluded from a neighborhood resource when it was desirable and then become a repository once it was shunned. And then the second quote is this. The story of fast foods relationship to Black folks is a story about America itself. So, here's the question, are there ways that you can think of that fast food and food systems could be reconceptualized to help address issues of justice and equity?

I would say that addressing justice inequity in food systems of which fast food is a part, is really about dealing with the other systems that govern our daily lives. Meaning, it's not an issue of trying to fix fast food, right? So, that is a discreet industry it behaves more equitably with communities because what it has done over the history that I trace in the book is it's not so unique in its practices and it also can't have taken the trajectory it did without intersecting with other institutional concerns. So, for example, housing is instructive because you know, of course you can't exploitatively target Black consumers unless residential segregation exists to concentrate them in space. And to do that, obviously you need a lot of different institutional policies and practices at play to produce that. And in a similar way, housing went from exclusion in the form of rank discrimination, resource hoarding, redlining, the denial of mortgages, all of that, to exploitation in the form of subprime lending. And Keeanga-Yamahtta Taylor talks about predatory inclusion and I type that in the book because I think it's also a useful way to think about fast food as well. So, if you're thinking about equity in food systems, then you have to think about why is it that resources including food, but also beyond food, in this country are distributed the way that they are. And I think you can't get at the issues of justice that play out for fast food or injustice without addressing the key issues that reverberate through it. And so that's false scarcities that are created by capitalism, the racism that undergirds urban policies around land use, around segregation, deeply ingrained ideas in the American psyche about race and but also about other things. So, for me really, reconceptualizing fast food is really reconceptualizing how we live in America.
 

Bio

Naa Oyo A. Kwate is Associate Professor, jointly appointed in the Department of Africana Studies and the Department of Human Ecology at Rutgers. A psychologist by training, she has wide ranging interests in racial inequality and African American health. Her research has centered primarily on the ways in which urban built environments reflect racial inequalities in the United States, and how racism directly and indirectly affects African American health. Kwate’s research has been funded by grants from the National Institutes of Health and the Robert Wood Johnson Foundation, and by fellowships from the Smithsonian Institution, among others. Prior to her first major book, White Burgers, Black Cash: Fast Food from Black Exclusion to Exploitation, she published the short work Burgers in Blackface: Anti-Black Restaurants Then and Now, which examines restaurants that deploy unapologetically racist logos, themes, and architecture; and edited The Street: A Photographic Field Guide to American Inequality, a visual taxonomy of inequality using Camden, NJ as a case study. Kwate has been a National Endowment for the Humanities Fellow at the Newberry Library, and has received fellowships from the Smithsonian Institution, the European Institutes for Advanced Studies, and elsewhere. She is currently writing a book investigating the impact of corner liquor stores in Black communities from 1950 to date.

A growing number of research studies show that the cognitive and brain development of low-income children differs from that of children in higher income families. For any family, that is a concerning statement. Today's podcast features a project called Baby's First Years, a multi-year effort to test the connections between poverty reduction and brain development among very young children. Here to talk about what the study has revealed so far is Dr. Lisa Gennetian from Duke University's Sanford School of Public Policy, and Dr. Sarah Halpern-Meekin from the La Follette School of Public Affairs at the University of Wisconsin, Madison.

Transcript

Sarah, let's start with you. What is the Baby's First Years study?
 

Sarah - So the Baby's First Years study is a study of how having additional income matters for children's development and for family life in families that had incomes around the federal poverty line when they had a child. And so, it includes two main components. The first is a randomized control trial that tests the effects of families receiving either a large or a small monthly cash gift each month, families get either $333 or $20 each month on a debit card from the time their child was born until just after the child's sixth birthday. Lisa and our colleagues, Katherine Magnuson, Kimberly Noble, Greg Duncan, Hiro Yoshikawa, and Nathan Fox lead this part of the study. They've been following mothers and children from a thousand families over the past six years. The other part of the study is a qualitative study in which we do in-depth interviews with a subset of those families because we want to learn more about how they think, about making financial decisions, the values and dreams for their children that guide their parenting and how they think about their money they're getting from Baby's First Years each month.

This study is complex and would require time to observe change. Can you tell me about the length of time your team has been doing this intervention?

Sarah - So the first families started the study in 2018.

Lisa - One thing that's unique about this intervention is its length. As Sarah mentioned, it's starts at the time of birth and it's monthly. And families will be receiving this cash for 76 months. So, they'll be receiving it through the first six years of their child's life.

Thank you for that detail. Lisa, what is the landscape for food programs and assistance in the United States, particularly for families with infants and young children?

Lisa - There are two major programs that are federally funded in the US that are particularly targeted for families with infants and children. One of them is called the Women, Infant, and Children's Program, or WIC for short. The WIC program, let's see, in 2022, served about 6.3 million participants, but it provides a mix of core nutritional needs, breastfeeding support, information and referrals. And the second big safety net program in the US around food is called SNAP, Supplemental Nutrition Assistance Program. This one's broader and has served over 40 million people in 2022. And together both these programs have been pretty core to providing food and nutritional support to families, including those with young children.

Thanks for that context. So now, how does the cash gift intervention differ from, or fit with other food assistance programs that these families may participate in?

Lisa - The thing that cash can add above and beyond that, so thinking about how this Baby's First Year study might help supplement resources is in two ways. One is thinking about how money that might have been spent on the foods that are provided by these programs are now being taken care of through these food subsidies. One direct way that the BFY cash money can help is by increasing those net resources available for other types of food or for other things in the household. It's a real compliment to these what we call in kind or conditioned kind of food subsidy programs. The second is that there are no conditions. And so, what WIC and SNAP provide, which is really formative and really important for a lot of families, is also has some real parameters on what could be purchased. And so having extra cash means sort more flexibility around direct food resources. And that's actually something we start to see a little bit in the Baby's First Year study.

Wow, Lisa, thank you for that. Given that these are means-tested programs, the cash infusion from Baby's First Year's project could influence participants' eligibility for other programs, right? How did you deal with that?

Lisa - Oh yes, it's a really great question. Thanks for asking that. For the purposes of this study, we, for several years, worked closely with all layers of government, federal, state, and local to think hard about how to protect the families receiving this cash gift from losing eligibility for these other programs because as you say, right, we're increasing their income implicitly through this cash gift. And so, we did that through some administrative rulings, meaning states agreed that the families would be exempt and to the states, we had legislation passed to protect these families from their eligibility being affected by receipt of the cash gift. We did that as comprehensively as possible. There are some exceptions, but we think that it's been pretty effective kind of strategy we use to ensure that families, when they get this cash gift, that they're not mechanically losing eligibility for these other programs. So, the way to think about this cash and supplementing people's lives and supplementing and accompanying everything else, is also helping how families might think about access to these other programs and choices around that in ways that they might not have had before.

That sounds like a large undertaking, and it took extensive planning to get to that point. I imagine you wouldn't want families to lose their benefits because they participated in this study. Sarah, I want to come back to you. What are families’ experiences with Baby's First Year and with government-provided food assistance programs in the United States?

Sarah - So families in both gift groups are appreciative of having extra money every month. That's even more so the case for those in the high gift group mothers not surprisingly, some mothers in Baby's First Year struggle to make ends meet, for others, even if they can cover their bills every month, having just that little bit extra breathing room is pretty welcome. Like Lisa was talking about across the country, in Baby's First Years, the vast majority of families have experience with food assistance programs, either currently or in the past. It's pretty rare for them not to, relatively speaking, while families often receive WIC, that's the Women, Infants and Children program that Lisa mentioned, when they have babies, many stop getting WIC after their babies turn one, despite the fact that they remain income eligible for that. Most families also receive some benefits from SNAP. And in some qualitative work that I did with my colleagues, Carolyn Barnes and Jill Hoiding, we heard from families about how they thought about engaging with the WIC program. They thought about the value of the benefits they could get from doing so, but also the costs of doing that, like how hard it is to make it to appointments, to fill out the paperwork to use those benefits once you're at the grocery store. And they weighed those costs and benefits as their children grew up when they were thinking about whether or not to pursue those benefits.

So Lisa, what are you learning from the Baby's First Year study about where and how families and children are getting food?

Lisa - So Sarah has talked about the richness of speaking to moms directly at holistic types of interviews. Alongside that, we've annually been going back and speaking to mothers and collecting information about them and their children. And part of our, so these are our annual surveys, they are in or near the children's birthdate, and we ask them a bunch of questions about how life is going, about their spending, what's happening with income and employment and childcare, their own health, their mental health. One of the areas that we focus on is around food. And one of those food items is called a food security scale. This is a six item, a USDA-approved scale. It asks questions like not having enough money to buy food, questions about hunger, questions about eating balanced meals. It includes a set of items that we would call pretty subjective. For example, the question on balanced meals, but also less subjective. Is there literally enough money to buy enough food for the household? And so, we're learning some really interesting things. First, we're learning that there is very high connection to this food safety net that we were just talking about. So, far majority of the families are connected either to WIC or the food assistance program called SNAP. And that's pretty consistent. Sarah just talked about a little bit of the drop off of WIC, but we certainly see consistent connections to SNAP, all the way through the first three years of the child's life. We see that generally as sort of a kind of good news story. So, these are families who are eligible for these programs, their family's drawn from four very different dates and sites. They're very diverse in their racial ethnic composition and whether they've been born or not in the US in terms of the moms. The fact that there is very high connection to a food safety net system while raising young children, we think is a really positive signal of the food safety net system potentially working pretty well. And then we're not seeing big differences between the high cash gift group and the low cash gift group on this food security measure. In fact, we're seeing pretty high food security amongst these families with very young children on the scale. That doesn't mean that any one of these items, we're not seeing high reports of things like scarcity. So even though the families are very low in food insecurity, we do see that about a third of them are reporting some kind of food scarcity. So, 31% report that the food they bought did not last and they sometimes often didn't have money to get more. For example, we're also hearing from families, they're relying on free meals from non-federal sources. We haven't talked yet about the importance of the faith-based kind of system and support and informal networks in providing food. We ask families this when their children were about three years old, and roughly 10% report some receipt of free meals from other sources. We are inevitably also seeing, as you might expect, some variation across these sites. So that's sort of a hint on what we're seeing around food security and connections to the safety net. We also ask about spending, and we're not seeing overall differences in how much money is being spent on food with one very interesting exception. That's on money, on food spent eating out. We don't ask a whole bunch of information about nutrition, but when the children were toddlers, moms do report, who are receiving the high cash gift, they do report higher consumption of fruits and vegetables among their toddlers. It is a very sort of unique and narrow question, but positive, so more fruits and vegetables and not more of other things like salty treats, flavored drinks, sodas, sugary sweets. And we're looking forward to continuing to follow up on items of nutrition when the children are four.

This is fascinating, and I'm so grateful that your team is paying attention to these families' experiences and engagement with the social safety net and the charitable food sector. Sarah, we often understand food, particularly healthy food, as a way to deliver nutrition that promotes health and development. Of course, food provides much more than nutrition. What, if anything, are you learning from the study about the social meaning of food and what it represents to families?

Sarah - I really appreciate this question because it's something we've been looking at and thinking about a lot in our research, in the research other people have done before, and in our own study we really hear a lot about the role that food plays in families, beyond nutrition. In so many cultures, food plays a really core role in social time and in family time. This can be things like turning family movie night into something a little more special by microwaving popcorn. It can be having special mom and me time with mom taking a child out to go get a cake pop at a coffee shop. It can be eating a meal at a sit-down restaurant to celebrate a special occasion, a child's middle school graduation, for some of these purchases, you can't use food assistance. And so having cash on hand is really essential to engaging in these kinds of special rituals and family time. Like your question implies, it turns our attention to the role that food plays in family bonding and in socializing. We really want to think about the multiple roles that food serves in our lives and how having this kind of extra income on hand for families who are often income constrained, can change these opportunities for those special family times around food.
 

Bios

Dr. Lisa Gennetian is an applied economist, Professor of Public Policy, and the Pritzker Professor of Early Learning Policy Studies at Duke University’s Sanford School of Public Policy. Drawing on perspectives from the behavioral sciences, psychology, and child development, her research focuses on the economics of child development, specifically child poverty, parent engagement and decision making, and policy and social investment considerations.

Dr. Sarah Halpern-Meekin is Vaughn Bascom Professor of Children, Family, and Community in the School of Human Ecology and the La Follette School of Public Affairs at the University of Wisconsin-Madison. She is also an affiliate of the Institute for Research on Poverty. She is a sociologist whose research focuses on family, adolescence, social policy and the welfare state, class and inequality, and qualitative methods. Her current research includes examining the role of parents’ churning (on-again/off-again) relationships in family life, exploring the experiences and financial decision-making of mothers who are receiving monthly unconditional cash gifts, and understanding how rural men make ends meet, spend their time, and make meaning while disconnected from the formal labor force.

Today's podcast is a story of one man's personal journey to making a difference by building communities. Zach Wyatt grew up caretaking an old 300-acre farm in Virginia. He went to college and ended up working in mortgage lending. And then something changed for Zack, and that's where the story gets interesting. He now leads the Carolina Farm Trust, working to strengthen local food systems in the Carolinas. The trust cultivates urban farm networks, farm apprenticeships, supports local farmers in purchasing equipment or land, making informed-decisions, and more.

Interview Summary

I'd like to understand a little bit more, why did you want to start the Carolina Farm Trust?

Well, with a lot of things, it was just kind of by accident and circumstance. And I would say subconsciously I had agriculture in my bones, ever since I was a kid growing up in agriculture in Northern Virginia. It just kind of seeps in. We [The Family] still have that little arm reached out to being a part the DC metro area. Growing up in an urban-rural environment kind of planted, I think, a lot of the seeds in the work that was going to transpire so many decades later. But it really just kind of came down to a life event. I had a partnership that just ended in one day, which was a huge blow to us financially. We had to get on EBT and Snap and went through that process. And I was really soul searching and figuring out what were the next steps for me. Looking back on it, I think I was really grasping on to how do I do anything, to kind of just do something. I got back into reading about our food system and farms and started meeting some farmers. And once you start talking to farmers in a real way and understanding what our food system truly is, it's horrifying. It kind of came down to seeing this visual metaphor of a meteorite heading toward us every day, and either sticking your head in the sand or doing something. Circumstance just led to this next event and next event, and the next event. And eight years later, here we are.

What I hear from you is this story of resiliency and it seems like that's something you also see in the food system or a need for that is that a fair assessment?

Absolutely. We just take food in agriculture for granted. And over the last 80 to 90 years, we've really given our entire means of survival pretty much away. Most people don't really look at food and agriculture and how it spins every major decision on Earth. Every social problem we typically have, every health issue we have, if you follow it all the way down to where that problem started, you go all the way back to the dirt. So, to kind of look at resilience and what do we mean by that and more importantly, building regional resilience in a global economy: I think getting supply chains a whole lot shorter, focusing on soil health and nutrition density and our farming community, is where we really have to start.

I'm starting to get a sense of the big picture of the farm trust. What is the driving mission of your work? I think you're hitting on some of that, but I'd like to hear more.

I'd say the vision is very clearly about building regional resilience and then using food and agriculture as a primary driver. The four main pillars we have are health and nutrition, upward mobility and equity, sustainability, and climate change. Our four action-on-the-ground pillars are first, building an urban farm network and to get people to understand where our food comes from. Why is that important? We do really need to push urban centers to be more responsible for where our food comes from and playing a role in that. Second, our farm apprentice program, workforce development. You know, the average age of our farming community right now is a little over 60. Where is this next generation of farmers coming from? Where is the land coming from? So, it is not only kind of a labor force for us, you know, but how do we make sure every community garden, every school garden is thriving? How do we create teams that can go help our rural farming community with different projects or step in when someone gets sick or an emergency? Third, when we think of food as health, what does that really mean? If we're talking about food as medicine, in my opinion, we've already missed the boat. We got to talk about food as health, we got to talk about prevention. How do community health workers get out in communities covering geographic locations, really understanding what those needs are and how do we create systems to go meet them where they are. And then our fourth pillar is our distribution platform, which is really there to give a profitable revenue stream to our farming community. How do we use economics to really push them to start their regenerative farming journey? And then how internally to create supply chains that not only can work with consumers, you know, up and down the socioeconomic ladder, but how do we make sure we can build supply chains for larger institutions to be able to participate in a local food economy because the infrastructure is just not there.

I was struck by your earlier comment of if you get down to the, if you will, root cause of any problem, and forgive the pun, it seems like it's in the dirt. Right? And I'd like to hear you explain a little bit more about what you believe is what's wrong with the food system as it is today. And I got a sense it's about the lack of being local, but I want to hear it in your words and how does this guide your actions now?

Well, it's just evolution. I mean we always try to get better. We wanted to make food cheaper, so we went from hundreds of farms and rapid consolidation over the years. We have processed and now ultra-processed food, and we have to deal with slavery and reconstruction and everything that kind of came with it with such as sharecropping from a social standpoint. We're looking at nutrition density and in average produce and protein sources we're almost 30 to 6% less than what it was 100 years ago. We're looking at climate change, sustainability. Where does that come from? Look at the carbon footprint, our agriculture industry puts on the planet, look at the massive consolidation of looking at if the world gets 40% of its grain from Ukraine, and then having different political and social issues come up. I include inflation spikes. We're looking at carbon sequestration, we're looking at no-till, we're looking at all these big environmental and all these sustainability and allergies and cancers. And so, where does all that come from? It comes from our environment. Looking through all of this, you can very much see parallels of how our food system started to consolidate and get more aggregated with all the other problems I just mentioned. And if you look at 1930, 1940, and then going from there, you can very much see kind of a parallel with a lot of the challenges that we face. So, I think we really spent a lot of time trying to kind of cherry pick among all these really big problems. We're trying to cherry pick smaller problems because they seem a little bit more manageable, but we really have to go rethink the system as a whole. And that's really, really hard to do. What we're really trying to push forward is how do we just look at a region, because I really feel like you have to do this from a regional perspective. How do we get a regional model to work, really go rebuild all that infrastructure, get, buy-in, understanding what the data's telling us, and then we can replicate that going forward to really other regions around the world.

This is very helpful and I appreciate the way you approach that question. Seeing that there are these large global issues and there are structural challenges when we talk about agriculture - and you're working in the region, my understanding, you're out of West Charlotte - and there's a distribution center. Can you tell us a little bit more about what you're doing in West Charlotte, especially through this distribution center?

It became very clear that our farming community needed a market. Farmer's markets are tough. As consumers, some of us love them, some of us don't pay attention to them. But for our farming community, farmer's markets are really hard. And from a wholesale standpoint, it's very hard for Carolina farmers to compete with Mexico, California, Florida. How do you compete regionally on a global market? So, we had a distribution model planned for a while and in my head, I wanted it to be in West Charlotte and it needed to be near I-85. We wanted it to be in a community because this kind of distribution facility would be an employment place and we would have a real retail concept. We wanted a meat processing butchery component. So, it was kind of putting a lot of pie in the sky visions into one parcel. But one of our strategic advisors in 2021 was at coffee, talking to a friend about Carolina Farm Trust and kind of what our needs were. One of them said, "Oh, my family has this warehouse," So we took a look at it, and it met every criterion we could have dreamed of. The only thing that was different was that I was thinking in my head we would want like 100,000, 200,000 square feet and this one was 25,000 square feet. But the moment I looked at it, I realized this is the exact size or the range that we need because of the community impact. We want more of these not one or two, you know, that are gathered around. This being in the community was such a key factor to it. So, with our wholesale operation, our commercial kitchen, the retail, the event space, the meat processing butchery component of it all, we really could start to see this framework of getting kind of an independent food system together. So, we're working on phase one, which is our wholesale operation and our 3000 square foot commercial which should come online, you know, in the next six weeks. And then we're just waiting on permitting for phase two and fundraising on phase two to get that activated. It's a really cool project and we're really excited to see it to come to fruition here in the next few weeks.

This is really fascinating. You know, I haven't asked this, but I'm intrigued. Tell me a little bit about the farmers that you work with. What kinds of produce or crops are they or animals are they producing? I mean, how are you developing those relationships?

Over the course of the years we've met a lot of different farmers and we grow everything that we can grow here in the Carolinas. We're talking greens and obviously tomatoes and melons and corn. We're working with our grain farmers who are growing wheat for us and grinding flour that we're actually getting into a hotel right now in Uptown Charlotte, which is really exciting. Cattle, pork, lamb. And really looking to create markets for our farming community in any way that we can. So right now, Michael Bowling, our general manager of CFT Market, which is the name of our distribution facility, he and his team are going all over the state and finding arms that we've never heard of and getting recommendations and compiling our list. A big part of what we're trying to put together is how we can take the burden on some things like transportation, because it's such a margin killer, and such a challenge for our farming communities. How do we get amazing produce from the east, you know, into Charlotte and the West, into Charlotte. So, we're working on getting a fleet of vehicles right now to do that. So, it's really just trying to find all of the barriers that our farming community faces, and then how do we create the infrastructure systems.

I want to end by asking sort of what are your hopes? Like what is the long game? Where do you see your work and the work of those who will follow you? Where does it lead?

Well, I think you have to be very naive to think this way. And sometimes, being naive isn't a bad thing because if you do too much research, then you think your way out of doing what you should be doing. So really, the long game is trying to change the entire industry. But it's so much more than that because our food and Ag is health. It IS our health industry, you know, and obviously it's our food industry. But it's also going to play a huge role in saving not our planet for the planet's sake but saving the planet for our sake. You know, it's just critical. So, I mean, really we're wanting to really follow in Netflix footsteps. Netflix came in and changed the entire entertainment industry relatively quickly. We're looking at automotive legacy manufacturers that weren't getting electric vehicles fast enough. So, Tesla came in and disrupted that. Now suddenly, everybody's moving in that direction. So really at our core, we want to take market share and drive our industry partners to focus more on this work. That is really the long game. For us, it's how do we build the foundation? I know I'm never really going to see it, but how do we build this foundation for the next generation of leadership to really get it going on what we've been able to build in this short time.
Bio

Zack Wyatt is the President/CEO of Carolina Farm Trust. Zack grew up tending to a 300-acre dairy farm in northern Virginia. After graduating from Coastal Carolina University in 2003 with a degree in Business Administration, he worked in home mortgage lending and IT. Zack’s passion for bringing the community together over food, his understanding of the importance of equitable food access, and his drive to improve local food systems led him to develop Carolina Farm Trust in 2015.

If people knew how much food they threw away each week, would they change their food-wasting ways? That's a question scientists explore in the 2023 State of Food Waste in America report. The research goal was to understand why and how households waste food, and what would motivate them to prevent food waste. In today's podcast, we'll talk with MITRE scientists Laura Leets and Grace Mika, members of a team who developed and launched the MITRE Food Waste Tracker app. This is a first of its kind app for households to log information about discarded food and learn ways to save money by reducing food waste. The Food Waste in America study team includes the Gallup Survey Company, researchers from the Ohio State University, the Harvard Law and Policy Clinic, ReFED, the Natural Resources Defense Council, and the World Wildlife Fund.

Interview Summary
 

Laura, let's begin with you. Can you give us a quick overview of why MITRE focused on measuring food waste at the household level and the behaviors?

Laura - In a general sense, Norbert, we know the United States waste 30 to 40% of our food, yet we do not know how much is wasted at the household level. We know that waste occurs along the entire farm to table supply chain, like approximately 15% with farms, 15% at manufacturing, about 20% at stores and restaurants and about 50% in the household. So, given that half the waste happens at the household level, it's important to measure it. If you can measure it, you can do something about it. Up to this point, people have not had an easy way to estimate their amount of food waste. So, to address this gap, not only did we develop a new way to measure household food waste and Grace will share more about that, but we also provided a baseline measurement of American household food waste.

I would like to really dig in a little bit more. How much food do American households waste, and do you have a sense of what kinds of foods people are wasting?

Laura - Let me start with the amount first. We found that the average American household wastes somewhere from 3 to 4.5 pounds per week. And there's two ways to measure household food waste. The first is you can focus on the edible or uneaten food. And with this measure, American households waste about on average three pounds per week. Second, you can add inedible food. So, that's your food scraps, your eggshells. And if you take edible plus inedible food together, then the American households wastes on average about 4.5 pounds per week. Let me give your listeners a couple analogies to understand that impact of that 3 to 4.5 pounds of household food waste. So, let's say we combine our own household food waste with everyone else's. The crop waste is large enough to cover the states of California and New York. From a personal perspective, imagine before every meal you scrape off 40% of the food on your plate. If you imagine that in each meal, you're going to start to understand that the current food waste is massive, and we're all contributing to it. So that's the measurement piece. I'm going to pass it over to Grace to discuss the types of food we're wasting.

Grace - Americans are wasting a wide variety of foods in their homes, but the number one wasted food type is your fresh produce. So, that would be your fruits and your vegetables.

I think this is really important to keep in mind, not only because, of course, fruits and vegetables are perishable, but when we think about healthy diets, many people in the nutrition space are encouraging fresh fruits and vegetables or fruits and vegetables in general. Ao this is a really important finding, and I'm excited to know this. But it's also important for our listeners to think a little bit more about this. Grace, I would like to learn a little bit more from you. Can you tell us more about the MITRE Food Waste Tracker, the app itself?

Grace - I would be happy to. The MITRE Food Waste Tracker app is meant to be a tool for households who want to understand exactly what's going uneaten in their home. If you had asked me what exactly I ate yesterday and how much of that went into my trash can, I would have a really difficult time remembering an answer to that question. And that's for just yesterday, let alone multiple days or weeks ago. Not knowing what exactly goes uneaten would make it really challenging for me to cut back on that waste. So, to solve that problem, our team designed an app which allows for food waste to be logged in real-time. So, right as you're doing your meal prep or you're clearing off the dinner dishes or emptying your leftovers out from the fridge. And the app tracks details both about the food itself, like where you got that from and the food group that it belongs to, as well as where, why, and how the food was thrown away.

And you can also track how much waste was produced, and we encourage you to use your hand as a guide to estimate the volume of that waste. So, your closed fist is about the size of a cup of food and your thumb about the size of a tablespoon. The more that you use the app to track, the more you will reveal patterns in the way that you waste. Maybe you find out that you're optimistically shopping for vegetables that your toddlers at home are just not interested in eating. Or maybe you're serving up heaping platefuls at dinner time, but then find that you're not hungry to finish that meal. So learning this will empower you to make small changes in the way that you shop for, prepare and store food to make sure that as little as possible is going to waste.

And if you're money-minded like many Americans are, you might be especially interested in an app feature which estimates the cost savings that you would experience if you cut back on your waste. So less food in the trash means more money in your wallet and the savings really add up. The average American family spends over $1,500 on wasted food each year. And tracking with the app is fast and simple. For each food that you dispose, you would simply click on the icons that best describe your waste. It would be really easy to get the whole family, even your your kids involved in tracking and thinking about the food that's going into the bin.

You've already touched on a few of these key findings about sort of the top foods that we end up wasting. Are there other findings that you would like to share with us?

Grace - So there are two behaviors that really stood out when it came to producing food waste. The first is simply being willing to eat your leftovers. Personally, I get really excited about leftover nights. It means I get a good home cooked meal with almost no prep work that evening. A lot of us are already doing this. About a third of Americans incorporate leftovers into new dishes and about half of us frequently eat leftovers just as a meal by themselves. Those leftovers add up. We found that households who consistently throw their leftovers away are wasting nearly four times as much as households that eat those up. We also found that households' understanding of and behavior around date labels plays a significant role in their levels of waste. A lot of us don't really understand how little date labels actually mean, and how little they're standardized. Not too long ago I was cooking with a friend, and we were making dinner together and he smelled a bag of shredded cheese and he said, "Oh, this smells kind of funky, but it's not past his date." And he added it into the dish. You should actually be doing the exact opposite of that. You should trust your senses over the date label when it seems that something is spoiling. There are some dates that are meant to be safety indications, but the majority are just a manufacturer's best guess of when food will pass its peak quality. And frequently, thrown away past date food that has no signs of spoilage so this leads to wasting over twice as much food. It can be easy to feel helpless when it comes to wasting food, but it's surprisingly simple to take control over your waste As we mentioned before, if you're curious about what sorts of behaviors are leading to waste in your own home, we have an app for that. So, our latest version of the app has new features to help you understand your waste and even get a sense of how much money you could be saving if you cut back on your waste in your home. I highly encourage you to check that out.

I’ve got to say I have done some work on date labels and have found this is an important area of consideration. But also, one where the modification of those date labels may actually help reduce food waste. I'm so happy to hear you talk about the sort of broader set of things that consumers can do to actually mitigate food waste in the household. You got into some of my own personal family issues around what do we do about leftovers, and I will not report this conversation to my family. So, thank you for that, Grace. Laura, I want to go back to you and ask about a big picture question. Why should our listeners reduce their household food waste?

Laura - Norbert, I believe I can make a compelling case for that. This is a rare opportunity when making a small change can have a large positive impact. Let me explain the amazing cascading ripple effect that happens when we reduce our household food waste. We had Grace reminding us with the app, and the first benefit is financial. An average American household can save at least $1,500 a year or $125 a month by reducing food waste. So just focus on that personal financial benefit, and then understand the resulting ripple effects. That first ripple effect is going to impact the ecology. Most of us don't realize significant resources go into producing food. The USDA reminds us that 50% of our land in America is used for food production and 80% of our water is used to produce that food. When we reduce our food waste, we're recognizing food as this precious resource, and we are supporting our food production industry. This is really important because America is one of the top food producers in the world.

The next ripple effect impacts food security. Food security is part of national security. When you reduce your household food waste, you are also supporting national security. Next is a societal impact. Reducing food waste allows us to optimize our food and feed more people. And, finally, there is a significant environmental benefit. The number one substance going into our landfills is food waste. As it decomposes, it emits greenhouse gases that cause this pollution blanket to surround the planet. That pollution blanket traps heat and warms the planet. So, when we reduce our food waste, it's one of the top three activities we can do to reduce warming temperatures and extreme weather events. We all have the ability to combat climate change through our household food waste. These small changes in our food waste - they're going to result in positive financial, societal, and environmental benefits. It's such a powerful, impactful decision to reassess your food waste and think about ways you can reduce it.
 

Bios

Dr. Laura Leets is an accomplished researcher, teacher, and mentor. She brings 30 years of experience from academic and industry environments.  She currently serves as an innovation lead and senior principal scientist at MITRE. In this leadership capacity, she works with researchers to identify, shape and conduct important, transformative, and impactful projects for government sponsors and the nation. She also serves as an adjunct professor at Georgetown University’s Communication, Culture, and Technology Program and previously spent a decade as a Professor of Communication at Stanford University.  She has been recognized with several top paper and teaching awards throughout her academic career. 

Grace Mika, B.S., is a data scientist in MITRE’s Modeling & Analysis Innovation Center, where she has worked on projects for the Center of Disease Control, Internal Revenue Service, Veterans Benefits Association, and the Office of the Undersecretary of Defense, Acquisitions & Sustainment. She is passionate about visualizing data in a clear, accurate, and accessible way. Grace was instrumental in the design of a first-of-its-kind Food Waste Tracker App, which allows users to track waste as it occurs within their homes. Grace holds a B.S. in Applied Math and Psychology from the College of William & Mary and is currently working towards her Masters of Analytics at Georgia Institute of Technology.

Dollar stores are the fastest growing food retailer in the United States, both by sheer number of stores and consumer food purchases. Just two corporations, Dollar General and Dollar Tree, which also owns Family Dollar, operate more than 35,000 stores across the country. However, a growing body of research reveals that dollar stores offer limited healthy food options. Dollar stores shape the food environments of communities, especially in the South and Midwest regions and communities in rural areas with substantial shares of Black and Latin people and households with limited financial resources. What do we know about the impact dollar stores have on these communities and the overall wellbeing of community members? The Center for Science in the Public Interest conducted a national survey to understand how people perceive and actually use dollar stores. Today we will talk with lead author of this study, Senior Policy Scientist Sara John.

Interview Summary

My first question is what do we know about dollar stores and healthy food access?

There are more than 35,000-dollar stores across the country. So, to put that large number into context for people like me who have trouble processing them, that's more dollar stores than McDonald's, Starbucks and Walmarts combined. As you also mentioned, just two companies, Dollar General and Dollar Tree, control nearly all of them. Dollar stores really play a large role in food acquisitions for households. They can be especially important for households with limited incomes and those living in rural communities. These smaller store formats are much smaller than your typical grocery store or supermarket and tend to stock fewer fresh and healthy items. So, the body of evidence is still growing and we're still trying to figure out really how dollar stores interact with the food environment, whether or not they're driving out existing or potential new grocery stores or whether they're filling important food gaps in communities that otherwise lack food access.

I am really blown away by the number. I must admit I did not appreciate that they have 35,000 stores across the US. I know that there is a growing body of literature, as you suggested. One of our colleagues, Sean Cash at Tufts has been working in this space along with others in various disciplines have been thinking about the role of dollar stores. I'm interested to understand why CSPI conducted a national survey of those or perceptions, and what were some of the key findings?

As I mentioned, there's a lot of outstanding questions we still don't know. There have been more than 50 communities across the country that have already passed policies at the local level to ban or improve new dollar stores in their communities. But we don't understand community perceptions, usage and just I guess more plainly what people want from dollar stores. So, CSPI really wanted to take a stance to make policy, corporate, and research recommendations on this very quickly and growing retail format. But before doing so, we wanted to really make sure that we're centering our recommendations around what community members really want from dollar stores. We decided to conduct a national survey. We ended up having over 750 respondents from across the country of people with limited financial resources that lived near a dollar store. I have to say we were pretty surprised by our findings, especially given this popular sentiment that we have seen in the news media and with a lot of the local policy action. I would say that we found overall positive dollar store perceptions that people really are relying on dollar stores for food. But I would say just as many people want them to make healthy foods more available, affordable, and accessible.

Could you help me understand how did people find them beneficial? What were some of the things that you discovered, in terms of the benefits? But I'd like to also hear what were the points of contention? Where did they want some difference?

Community members had overall positive perceptions. I think there was about 82% of the survey respondents said that dollar stores helped their community rather than harmed it. And a lot of the key things that came up in the qualitative responses in our survey and the focus groups that we used to inform the survey was this overarching multifaceted concept of convenience. People said things like the store proximity, that they didn't have to walk a mile within the store itself to get to milk, and just an overall quick shopping trip. They also mentioned the affordability of products there. You know, not having to say no when shopping with their kids to something that's on the shelf. And then also a selection of specialty items - a lot of like different seasonal fare and things. Even using the phrase "thinking of the dollar stores as like going on a treasure hunt." You never quite know what's going to be there on the shelves. However, as you mentioned, there was also many deterrents listed for dollar stores as well. Things they could do better. So, low quality of products, the lack of predictable product availability, sometimes having bare shelves or not enough store supervision to be able to keep those shelves stocked. And also, the store appearance, both inside and out. Things like graffiti, trash, cluttered aisles. Those are all things that people that both shopped and did not shop at dollar stores noted in the survey. And all of this also kind of leads to another key theme that I mentioned at an overarching level, that people really wanted dollar stores to do more in terms of making healthy foods more accessible to them. So, 81% of our survey respondents thought dollar stores should stock more healthy items, and nearly as many thought they should do more to market and identify healthy options. We also included a list of more specific interventions of things that dollar stores could do to make healthy products more available, accessible, and affordable and one of the top responses was to provide SNAP fruit and vegetable discounts, kind of as one might see in like a Schumacher Nutrition Incentive Program at dollar stores as well.

I'm really intrigued by something you all did in the survey. You looked at differences, particularly between SNAP participants and those who potentially are SNAP eligible, but non-participants. Are there any key findings you want to highlight about differences between those two groups?
 

Yes. Many respondents generally mentioned being able to stretch their budget at the dollar store and this included more SNAP participants purchasing more food with their SNAP benefits at dollar stores. So, this was across many healthy food categories. We also saw SNAP participants felt more strongly that dollar stores should be held more accountable for the health of their communities as well.

This is really fascinating. These findings are part of what leads you to some of the key policy recommendations. I'd be interested to understand a little bit more about what are the policies that you all thought should be considered or corporate response and even research action based on these findings.

I'll highlight just a few. You know the first one at the federal level is strengthening SNAP retailer stocking standards. So, the vast majority of dollar stores do participate in the SNAP program and currently SNAP authorized retailers are required to stock a small number of items. So, three varieties of items across four different categories. However, if the SNAP program did have stronger stocking standards that better aligned with nutrition promoting foods like in the Dietary Guidelines for Americans, then all SNAP authorized retailers including dollar stores, would be required to stock more healthy items to participate in the program. Which is of course a huge benefit to the community. But also, a really important part of the business model of SNAP authorized retailers including dollar stores. At the local level, I already mentioned that more than 50 communities across the country have passed local policies, mostly to stop the spread of dollar stores such as through dollar store density ordinances. These look like saying a new dollar store can't locate within, let's say an existing mile, of a current dollar store. However, these policies are really only getting at new dollar stores and don't really do anything to address the existing 35,000. We also see an opportunity to strengthen and improve upon these existing policies and address what we found in the survey that community members want by requiring dollar stores to stock healthier food, make it more available, such as through healthy stocking standards or healthy food overlays in the local zoning code or even exempting dollar stores from these dispersal limits if they do stock a specific variety or number of healthy staple foods. At the corporate level, we're hopeful that this survey and its results make the business case to dollar stores for stocking healthier foods, making them more widely available. We've seen already actually both Dollar General and Dollar Tree moving in this direction. Dollar General, especially. I think about 16% of their current stores now do offer fresh produce. So, they're building out their supply chain, their distribution centers, and I would say retrofitting and redesigning stores to be able to make more fresh and healthy foods available. But we think they can do more, and especially do more in terms of prioritizing fresh food expansion in areas with lower incomes and limited food access. Many of these dollar store models started by locating in rural areas. We think if they could really leverage their ubiquity and where they're currently located to spread healthy food access to those communities especially, it could make a really big difference. We also have seen dollar stores in recent years put out public environmental social governance or ESG priorities. We think that these should be expanded and really prioritize healthy food access and nutrition goals. And one more thing I'll say around corporate recommendations is the expansion of the Special Supplemental Nutrition Program for Women Infants and Children or WIC authorization of dollar stores. Currently, based on our scan of the current list of WIC authorized retailers, there are no corporate dollar stores that are currently WIC authorized. By participating in WIC, and by adhering to those much more rigorous healthy stocking standards, it could do a lot to make a variety of healthy product, fresh produce, whole grains, dairy, baby food, formula more accessible to moms and kids.

I have to ask this question as a researcher, what are some important questions that the survey really prompted you to think more about or would like to have others come in and support research in this area?

There are so many. As I mentioned, the evidence in this space is really nascent, but is growing. So, one thing I would highlight is that we really are proud of this survey and its national scope. However, the survey doesn't reflect all communities and their desires and wishes. And so we hope that this survey could be used as a model and could be replicated in local communities to inform local policy and corporate intervention. We also think there's a lot to still do to better understand the current dollar store food environment. There have been some studies that have been done at small scale in some states and localities, but we think that current instruments could be better adapted and specifically tailored to the dollar store environment to better understand them and their variation across the country. Especially as we start to see this shift in corporate practices. There is a lot of, again, variation in terms of different dollar stores and what they're offering. We also really hope that we could see dollar store corporations, and maybe this is overly ambitious, but to collaborate with researchers to better understand what corporations already know, to better lift up what challenges are associated with increasing the stock and availability of healthier foods. We know that cost space and supply chain complexities, this is not an easy solution, and so how can researchers work together with corporate dollar stores to figure this out. Also, we'd be really interested in piloting healthy food marketing interventions, thinking about how this shift in healthy product placement, price and promotion might be impacting customer purchases, customer food consumption, and ultimately health.

Wow, this is a great set of ways for a variety of researchers to come in. It sounds like not only could academics do some of this work, but it sounds like there may even be space for citizen scientists to come in and look at what's going on in the food environments where they are to help inform that conversation. I think this is really fascinating. What's next for CSPI's work on dollar stores.

CSPI really hopes to be able to support efforts to advance the recommendations we've made in this report. At least one I'll highlight that we've already started to work on, is we just launched a corporate campaign; Don't Discount Families, Dollar General. Really pressuring Dollar General to improve healthy food access at their stores through these WIC expansion efforts that I referenced earlier. So, making sure that dollar stores expand their healthy food offerings by adhering to those more rigorous WIC stocking standard requirements. Making those foods both available and more accessible to moms and kids participating in WIC. You know, that includes fresh, frozen, canned produce, whole grains, dairy, healthy pantry staples, baby food and formula, but also in doing so makes healthy foods more available for any customer that walks through a WIC authorized Dollar store. I would mention that in ways that you can get involved, please feel free to reach out to me if you're doing aligned work in this space. We also have a petition that consumers can sign onto, and we already have generated over 7,000 emails to Dollar General and that number is still ticking, so please join our coordinated advocacy efforts and we also working on a sign-on letter in terms of coalition building to get organizations and researchers who are supporting healthy food access through dollar stores. So, I encourage everyone to check out our resources and again, please be in contact if you have any questions.

Bio

Sara John is a Senior Policy Scientist at the Center for Science in Public Interest and leads the organization’s federal policy and private sector efforts to create a healthier, more equitable food retail environment. Prior to joining CSPI, Sara served as the Evaluation Director for SNAP incentive programs across New England and worked at the Partnership for a Healthier America. She has a PhD in Food Policy and Applied Nutrition from Tufts Friedman School, an MS in Education from Johns Hopkins University, and a BS in Biology and BA in Public Policy from University of North Carolina at Chapel Hill.

How did the Nutrition Facts label come to appear on millions of food products in the U.S.? As Auburn University historian, Xaq Frohlich, reveals in his new book, "From Label to Table: Regulating Food in America in the Information Age," these seemingly innocuous strips of information reveal the high stakes politics that can help determine what we eat and why. In today's podcast, Frohlich will explore popular ideas about food, diet, and responsibility for health that have influenced what goes on the Nutrition Facts panel and who gets to decide that.

Interview Summary

I'm really happy to have you on today's podcast. So, why don't we just jump right in. What would you say are the key historical moves in the food policy arena with respect to labeling?

One of the things I talk about in this book is an informational turn in food politics. And what I'm specifically referring to there is a shift since the 1970s from an older way that the Food and Drug Administration approached regulating the market to its current focus on informative labeling. So, at the beginning of my book and at the beginning of the story, in the 1930s, 1940s, the FDA was trying to handle this big market full of lots of different products, especially packaged and processed foods. And under the legislation in the 1938 Food, Drug, and Cosmetic Act, authorized food standards. And the idea was that for any mass-produced food, they would hold hearings. People would say, "This is what we think the food should look like." They would then publish the standards, which would look kind of like a list of ingredients and ranges of the ingredients they could use, and then say, "Okay, all foods have to be the standard form of food. If not, we will either remove them from the market or call them imitation." And this was a system they used for decades, and it created a lot of problems. Then, late 1960s people started to get unhappy about this. There was this big turning point connected to the White House Conference on Food, Nutrition and Health where Nixon administration brought together lots of nutrition scientists. And one of the conclusions that came out of that is we need to change the FDA's system. And so, in the early 70s, the Food and Drug Administration says, "We're going to pivot away from these food standards and start focusing on informative labels." This is when you get the requirement of ingredient labeling on all foods, including standard foods, and you also get the first voluntary nutrition information label. My book looks at this change in strategies away from standardizing foods towards standardizing information about foods and creating these kinds of consumer-oriented information labels.

I love the fact that you helped us understand this idea of the information age, because once you read that and think, "Oh, well you're talking about something about the internet," but it's even more foundational about how we communicate what is a product. I found it really fascinating to read in your book where you talked about what I perceive to be really laborious conversations around what exactly is peanut butter or some other product. I mean, it seems like that took up a lot of space. Do you think that was ultimately productive? Is that the reason why we see this information change? Or was there something important about that effort on its own?

So, there were advantages and disadvantages of the old food standards approach. One of the advantages is that everybody who wanted to raise an issue was invited to attend those hearings. This meant that you could have really colorful exchanges. There is one woman who ran a homemaker's association who would show up and she would get a lot of attention because she was very colorful in her criticisms of proposed standards. It could be a very democratic space in that sense. On the other hand, they could run on for years. And there were contentious hearings where you would have dozens of lawyers from different food companies. It was held like a kind of legal court proceedings, and there would be objections, and counterevidence, and counter-witnesses. One of the complaints in the 1970s is that this was another example of an overly burdensome centralized government agency and process that was expensive. And the switch towards using informative labels and moving away from food standards was seen to be a kind of lighter touch form of governance. The disadvantage is that now you have an even more backstage discussion about what goes on this label, and it means that consumers have even less access to who's making those decisions for them.

Can you talk a little bit more about that? What's in the backstage that we're not privy to?

I think one of the misconceptions about the food label is that it is this window into the food, right? Especially something like nutrition and ingredients. You look at packaged food and you don't know what you're seeing, and therefore if they require the company to print the ingredients and nutrition, then you can look at that and now you have the kind of answer. In practice, it's more complicated deciding what kind of information appears there, which nutrients do you want to do, how do you calibrate those in terms of the daily diet? Or how do you name the ingredients? Do you use the scientific name? Do you use the common name? Those questions are decided by people backstage. This could be FDA regulators. They could allow companies to make those decisions. And so, the label is actually a translation of those kinds of decisions. One of the arguments in my book is that you can't get away from the values of these expert communities in deciding what goes on that label.

Yes, and thank you for that. I am really intrigued by how you are talking about the role of FDA, and I want to come back to that in a moment, this sort of panel of experts, and something that we think is so foundational, foods that we eat. We should know what they are. We believe we know what they are. They're part of our larger history. But what I'm also hearing is actually government organizations mediate what we understand food is. I'm intrigued to learn some more. Given what you've learned about the history of food labeling, what do labels offer as a policy tool?

Often the way people see food labels is that is a kind of knowledge fix, especially with packaged foods. Because you don't know what's in them, there is this sense that there's a kind of uneven playing ground between the producer and the consumer, right? The producer knows how it was produced. They know what's in the food. They're selling this to consumers and there's concern that they might mislead the consumer. And so, this idea is that the label is a kind of technical solution to that market problem. And in many ways, it can work this way, but there's actually a kind of translation work involved in there. It's a more complicated story than just a knowledge fix. And in fact, a lot of studies that look at how people read ingredient labels, and especially nutrition labels, will talk about how they fail to understand this or that aspect of the nutrition label. Because consumers are dealing with decision fatigue, they're in this, what people call the attention economy, where they don't have a lot of time to look at labels. So often, reading the label is the least important part of food labels for policy. In fact, over and over again, in this history, I discovered that when the FDA was introducing changes to the food label, regulators and others would comment on how actually the biggest impact is that it would lead to companies changing the foods before. So, even if consumers aren't reading the label, they're affected by those changes because companies are reformulating the foods.

I'm really interested in that. I know that there is a body of literature that talks about this idea that by having to put the information out in the public, what you're saying is companies reformulate because they want their products to look better, or maybe they actually are making the products better. Is that a fair assessment?

I think this is where you get into the tricky aspect of what we mean by better. So, taking the example of the nutrition label, one of the problems that you get with the beginning of nutrition labeling in the 1970s is it really favors a particular idea of what is better. So, if better means more of certain nutrients like protein or vitamins, and less of other nutrients like fats, or certain bad fats and sugars, then companies might reprocess a food, right? They'll take out sugar. They'll take out fat in it. And maybe they'll add in other ingredients to make it taste good anyway. And they'll kind of game that profile. And for people who are concerned about nutritional health in this sort of sense of nutrition, this might be great. But if your idea of good for you is less processed, you know this older idea of wholesome, you have this idea that the food was made in a kind of traditional sense, now you have a less good food. One of the problems that nutrition labeling raises is that it's not that it's misleading consumers, but it's getting them to focus on certain attributes of the food and not thinking about other things that may be important for health.

That's really helpful. I'm doing some work on date labels, and I've been thinking about this idea of how far can these labels go, and helping people make the best choices possible, however we define best. And that these labels are, as you said, the beginning. They're definitely not the end of that decision or that process. So, this is a really a rich conversation. I want to ask you about misconceptions. What would you say is the biggest misconception about food labels from the point of view of consumers? You gave us a little bit of an idea about that, but I'd love to hear your thoughts on this.

One of the misconceptions about the food label is that it is this window into the food, right, especially something like nutrition and ingredients. When consumers receive this information label, they often take it at face value as sort of, "I now have this information about the food." And therefore, if they require the company to print the ingredients and nutrition, then you can look at that and now you have the kind of answer. In practice, it's more complicated. Deciding what kind of information appears there, which nutrients do you want to do, how do you calibrate those in terms of the daily diet? Or how do you name the ingredients? Do you use the scientific name? Do you use the common name? Those questions are getting decided by people backstage. This could be FDA regulators. They could allow companies to make those decisions. And so the label is actually a translation of those kinds of decisions.

One of my arguments is that you can't get away from the values of these expert communities in deciding what goes on that label for the informative label. And in my book, I really try to argue that it's not just a kind of conduit into the product. It's not like suddenly you have the information. Instead, you need to read these labels as kind of value and political discussions among people who often have to make compromises. My favorite example of this with the nutrition facts panel was a decision to use the 2,000-calorie amount for daily values for the average American consumer. I remember interviewing a guy at the FDA, and I asked him about that, and he said, "Well, actually that's not accurate." It's not like if you averaged out everyone's caloric needs. Even in the 1990s, based on what they knew then, it would've been 2,000. For men, it was much higher. It was like 2,350. For women, it was lower. But they settled on 2,000 as a kind of pragmatic decision for multiple reasons. One, they hoped that if it was rounded, consumers wouldn't think of it as like a precise tool and it would be easier to do math with. And also it was on the low end of what you should get. So, the idea was that this would discourage people from eating too much. So, they made all these kinds of compromises in it. But if consumers see this and they see it as a kind of science, then they tend to think it's more rational than it really is.

And that's the kind of thing I was most surprised about from doing this history was discovering that actually consumers aren't reading these labels as rational calculators. They're reading them emotionally. And the best example of this I got was interviewing Burkey Belser, who recently passed, and he was the head of the design firm that designed the nutrition box label. And he described it as a government brand. And he said, you know, "Seeing this thing everywhere, it's not just about how people read it. It's there in the background, kind of like brands and logos." And it's that emotional relationship to the information that I think policymakers really need to think about with labels, not just seeing them as a kind of rational decision-making device, but as something that is shaping consumers' emotional decisions about the food they eat.

You've raised an important point for me, because I was going to ask, what do you think policy makers may be misunderstanding about these labels? I'm wondering, do policy makers understand these labels as a brand, a government brand? Are they capturing or dealing with the things that you're just talking about, the emotional connection that consumers have with these products or these labels?

I think that one of the advantages of labeling, and I think this is why the FDA started looking at it more as an important tool in the 1970s, is that it's a lot easier to focus on the package as a kind of site where you can police market behavior. So, it's much easier to do that than to go into manufacturer's factories to kind of say, "This is good, that is bad." You can use it as a kind of accountability device. I think from the point of view of regulation in a big national and increasingly international market, that's one of its advantages. The limitations of this for reforming food systems in my opinion, is it also ends up being a kind of outsourcing of work onto consumers, right? Instead of saying, "We want to make sure foods are safe and nutritious. We want to avoid certain kinds of ingredients or discourage certain kinds of unhealthy foods." Governments are basically saying, "All right, we're going to put it on the label and let the consumer do that work." And I think that is one limitation of them. The other thing that I also think happens is it's not just outsourcing to the consumers, but it's also putting that in the market and using the market to solve those kinds of problems. And for mandatory labels, like the nutrition facts panel, this means that consumers who have the time and resources might end up adopting a healthier diet because of it. But many consumers who don't have those kinds of choices aren't going to be helped by this informative fix. For voluntary labels, and this is something I talk about at the end of the book. I call them lifestyle labels or risk labels, depending on what you're talking about. So organic, carbon footprint labels, concerned about the environment, these kinds of third-party certificate labels, it becomes this kind of opt out. Instead of reforming the political system, you're providing this kind of market upsell option for consumers to have those resources.

I'm intrigued to think about the FDA in its historical place. Your book provides a history of past FDA activities on food labeling, and you talked wonderfully about those already. How does it speak to current policy concerns at the FDA? And you were giving a little bit of an indicator of that with the front-of-pack labeling. I'm wondering are there other spaces about FDA concerns today?

I think if you're really committed to reforming the food system, then food labels are only ever just the start to that reform work. They can't be treated as the solution. And I think in the past you have had a lot of cases, particularly with public government, where the label is put forward as the kind of answer to a political problem. And then they don't think about the need for staff to keep the education up about the label or enforcement. And so, they don't treat it like the beginning of that reform work.

One of the things I find really exciting about what your book is doing, that you're a historian and you're talking about the development of this policy and it has important implications. What do you think history offers us in the current policy discourse? What do you bring to the table that we miss out by not talking with historians?

So, when I was doing this research, this event that I didn't know happened that turned out to be really important in this story was this White House conference in 1969. At the time, the impetus for this conference was the sort of sudden public awareness of ongoing hunger in America. In the 1960s, people who were involved in civil rights realized that if they could focus on the issue of hunger, they could get a broader attention to problems of poverty and disparity in America. In 1968, this became a big public issue because of widely watched TV documentary. Everyone was talking about hunger and its connection to poverty and inequalities in America. And when the Nixon administration created the White House conference, the language of poverty and the concern of poverty was central. Then, there was a kind of shift over the course of the conference. Initially it's talking about hunger and how that's a malnutrition issue related to poverty. But by the end of the conference, they're starting to focus on consumer education, better labels, better information. And in some sense, we haven't got away from that framing shift. I really saw this recently with the Biden administration. It held its own White House Conference on Hunger, Nutrition and Health in 2022, and nowhere in its report was there a mention or discussion of poverty. They were really focused on foods as a vehicle for health, improving labels instead of talking about poverty as the kind of root concerns. Again, the kind of overall framing is if we engineer better foods in this nutritional sense, or we give you better information labels, then we'll solve the health problems America's facing. I think that that policy focus is ignoring the broader context of how Americans eat and how they're making their decisions. So, I see my book as kind of providing a broader lens to think of the issues, not just historically, but also looking beyond sort of the field of nutrition or considerations of government, but looking at how these different institutions are all interacting with each other to shape policy. I think the two important things here are about what history can offer in present policy. One is that I actually think a lot of people working on these issues today have no idea where they came from. I've experienced this as I've given talks. I've had people in industry, or people who work on policies sort of say, "I didn't realize that that was where the standard for milk came from," when they were talking about recent changes in terms of the nomenclature for milk. Or "I didn't understand that," you know, "healthy, as it was defined in the 1990s, was in the context of one kind of health war, but today there's a kind of new public health concern about other types of foods." So, part of it is that I think that policymakers will really appreciate getting that older context. I often call it institutional memory because you lose that institutional memory. The other thing that's really striking is, at the beginning of my story in the 1930s and 1940s, nobody was using words like saturated fats or carbohydrates. It was a different era and people were really talking about food differently. So, it's useful. I think of it as like study abroad. You know, you go to this place, you see that people are talking very differently, and then you come back to your home country, you know, or the president, and you realize, "Oh," you know, "there's this aspect of food that I was taking for granted that has really changed in the last," you know, "five, six decades."

Bio

Xaq Frohlich is Associate Professor of History of Technology at Auburn University. He works on issues relating to food and risk at the intersections of science, law, and markets. His research focuses on the historical intersections of science, law, and markets, and how the three have shaped our modern, everyday understanding of food, risk, and responsibility. His work explores questions relating to consumerism and the changing relationships between the state, experts, and the public in the production of everyday knowledge: how do we “know” what we know about food and its relation to health? In what ways has our informational environment for food changed with the industrialization of food production and retailing? Frohlich earned his PhD in history, anthropology, and STS at MIT. He teaches courses on food and power, the intersections of science, technology and the law, and the history of business and capitalism.

In 2022, Congress established Summer EBT, the first new permanent federal food assistance program in almost 50 years. The authorization of Summer EBT represents a historic investment in the nutrition and wellbeing of almost 30 million children who will qualify for the program. But states that piloted Summer EBT, or operated Pandemic EBT programs in the early years of the COVID-19 pandemic know that getting these benefits into the hands of families will involve overcoming complex challenges related to data and technology. That's why Code for America and No Kid Hungry, a campaign of Share Our Strength joined forces to create the Summer EBT Playbook, a comprehensive free resource designed to help state agencies plan for and implement a human-centered Summer EBT program. Today we will talk with Eleanor Davis, director of Government Innovation on the Safety Net team at Code for America. In her role, she helps government agencies adopt best practices for human-centered digital benefit delivery.

Interview Summary

Why is Summer EBT significant?

Well, I think you gave us a good intro. Summer EBT is a brand-new benefit program and it's designed to reduce childhood hunger during the summer months by providing families with a monthly grocery benefit to feed their kids when they're not receiving meals at school. So, almost 30 million kids in the US receive free or reduced-price meals at school, but during the summer many of them struggle to access nutritious food because they're not receiving those meals at school. School is out of session. Summer EBT is designed to give families $120 per child in the summer to help them buy groceries and it really has the potential to dramatically reduce childhood hunger. It's a tremendous moment because Summer EBT is the first new permanent federal food assistance program in almost 50 years. For those of us in government or in the food access space, this is really I would say, a once in a generation opportunity to shape the implementation of the program to make sure it really meets the needs of families and children.

So, why did Code for America and Share Our Strength develop the Summer EBT Playbook? What was the challenge?

Code for America is a 501 C3 nonprofit organization. We partner with government at all levels to make the delivery of public services more equitable, more effective, and more accessible using technology and data. And we've spent the last decade helping states deliver safety net benefit programs in more human-centered ways. The Summer EBT program, as we mentioned, has immense potential, but we also know that states are going to encounter many challenges in implementing this program in 2024 and beyond. I think standing up a brand-new benefits program is a huge undertaking generally, but Summer EBT will present some really specific challenges to states and we learned a lot about this back in 2020. So, at the start of the pandemic, Congress authorized an emergency response program called Pandemic EBT, that was very similar to Summer EBT in many ways. It was the same idea, really sort of providing families with a grocery benefit while schools are closed because of COVID-19. And so, in 2020 and 2021, Code for America worked directly with about a dozen states to help them deliver Pandemic EBT benefits. And through that process we saw very up close what made that program so hard to implement. Delivery of the program really relies on effective data and technology systems. So, really being able to find the right data in state systems and use that data to deliver benefits. And a lot of these challenges will also be true for Summer EBT, right? It's a very similar delivery process. So, states really needed help planning for Summer EBT and really designing systems and processes that will help them operationalize this brand-new program so that it can really live up to the promise spelled out in the policy. So, that's why we partnered with the No Kid Hungry Campaign. We really wanted to develop a resource that would help states design effective and human centered Summer EBT programs. And our goal was really just to sort of help as many states as possible implement this program.

This is really interesting, and I would like to understand a little bit more. What challenges did states face in implementing the pandemic EBT and how do you see that showing up in the Summer EBT? I mean is it just getting the right software or is it something else?

There are so many really, it's less about the software and more about the data. So fundamentally, I think some of the biggest challenges that we walk through in the playbook certainly, but that we know states are going to struggle with is really around using data to determine who is eligible for Summer EBT. So maybe just taking a step back, there are sort of two pathways for confirming who's eligible for Summer EBT. The first is called streamline certification. Basically, this means that the state uses the data that it already must determine if a family is eligible for Summer EBT and then issues those benefits automatically. So, for example, if a child is already participating in a program that should make them eligible like SNAP or in some states Medicaid, they should automatically receive Summer EBT. And similarly, if a child is in the foster system or is in a Head Start program or if a child has applied for and is therefore receiving already free and reduced-price meals at school, those children should receive Summer EBT automatically. But children who can't be certified as eligible through any of those pathways will have to apply for the Summer EBT benefits. So that's sort of the other eligibility route. States must provide a way for families to directly apply if they can't certify them through streamline certification. So, the idea is that the majority of children who are eligible for the program should actually get benefits automatically through streamline certification. And that's really fantastic, right? We should always be looking for ways to reduce the administrative burden that low-income families face when they aim to gain access to programs they're entitled to. So theoretically, if a state already has enough information to say this family is eligible for Summer EBT, they should just send that money out automatically and without the family having to do anything. That's sort of the best-case scenario. On the state side though, this is actually really complicated to do. The data that states need to use to determine that eligibility is all over the place, right? It's in Head Start programs, it's in the foster care system, it's in a state's SNAP or Medicaid eligibility system and it's in the schools, and school data presents really specific challenges for states to be able to use. So, states therefore have to identify where is all this data? What systems is it in? What agencies have this data? They then must aggregate all that data in one place that's central and usable. They have to clean and de-duplicate and match all that data across those different data sources. And then of course they have to deal with any inaccuracies or gaps in the data. So, data collection, data aggregation, data management, these are really sort of the core challenges of implementing this program. How do you collect all of this information into one place and use it to deliver benefits to families? This is really one of the core challenges that we focus on in the playbook.

It's really helpful to hear how you all are helping states think through this. And I would imagine that there are some differences across states. How in the playbook have you been able to best manage the uniqueness of these different states?

It's really tricky. I think we always say if you've seen one state system, you've seen one state system, no two states really look the same. And I'm using state really as a shorthand, tribal nations can implement this program, territories, US territories can also implement this program. So, there really is no one standard way that states backend infrastructure looks. And even when it comes to implementing this program, Summer EBT, different state agencies are sort of taking the lead in different states on administering this program. So, I think we're doing our best to help understand what unique challenges states are facing while also recognizing that the sort of themes, the main things, the primary challenges are going to remain the same basically across a lot of states. And so, we are really sort of in the playbook offering best practices, recommendations that we know will be universally helpful no matter really what a backend state system looks like.

Can you give us a little bit of the flavor of those best practices?

Absolutely. So, I want to talk about a couple here because this program gets really weedy really fast. I think the first one that we really talk about is client support. As we've been discussing, this is a really complicated program to administer. It's also brand new, right? So, families are going to need support navigating this program. They're going to have questions; they're going to be confused. Even after multiple years of Pandemic EBT, many families were still confused about why they did or did not end up receiving benefits. So, who is eligible? Can I expect these benefits? How do I get them? These are all questions that families are going to have. So, states need to be prepared to provide really consistent and clear communication to families. And they also need to have really easily accessible pathways for families to reach out and ask questions when they have them. And we can already really anticipate what a lot of those questions are going to be. One of the biggest points of confusion for families is going to be, "Do I need to apply or not?" Right? We talked earlier about the two different pathways streamline certification or filling out an application. From the state perspective it's pretty clear, but as a family, how do I know if I can expect to receive these benefits automatically or if I need to apply? And the complicated policy language here, of course you know about streamline certification, families don't understand that, right? We have to sort of really communicate clearly with families. I think one example of this is families whose children attend community eligibility provision schools or CEP schools; these are schools that serve free meals to all of their students. They're usually schools that are in low-income areas and because a certain percentage of their students are categorically eligible for free meals because they participate in other programs like SNAP or TANF, they're able to just give free meals to all of their students. So, families at CEP schools have never had to apply for school meals, their kids just get them. But because these families haven't applied for free or reduced-price meals, they're actually going to have to apply for Summer EBT. You can see how from a family perspective, this starts to get really confusing from a messaging standpoint, right? We're telling families if your income was below this level, at any point in the previous school year, you're going to be eligible for Summer EBT. But if you haven't applied to free or reduced-price meals this year, you have to apply unless you already received SNAP or TANF, in which case don't apply, you'll get benefits automatically. So, the messaging starts to get really confusing. How states communicate with families about this program and how to access it really matters. So, in the playbook we have a lot of resources on best practices for community outreach, how to talk about this program, how to leverage many methods of communication, right? Like email, text, phone calls, to really let families know about this program and give them the information they need to navigate it.

Wow, that's great. And it's interesting to hear you talk about this because early on I had the impression you were really worried about the data, but you're also really concerned about how people function in the system. So, I've heard you mention this idea of human-centered design and human-centered digital benefit delivery. Can you explain a little bit more about what that really means and why it's important?

Human-centered design really just means creating things that really meet people's needs and that are really easy for people to use and access. And that's really important, right? Just like the example I was just sharing with this program. It's a complicated program and if the systems aren't designed in a way that makes it easy for families to access, easy for families to interact with, they're not going to see the benefit of the program ultimately, and the program isn't going to meet its goals, which is reducing childhood hunger. So, the principles of human-centered design are really about thinking through what do families need when it comes to interacting with this program and how do we design the program in such a way that gives them those things? I think a great example of this is the application, right? We have a lot of best practices in the playbook related to the application component of the program. I mentioned that while many families will receive benefits automatically, the regulations for Summer EBT do require that many families will have to apply. So, states have to design applications and there are a lot of considerations that need to go into creating an application in a human-centered way, right? It needs to be accessible, which means it needs to be available in a lot of different languages, which can be really tough. California has 19 threshold languages that people speak. So, we need to translate this into the languages that people speak. The questions need to be written in what we call plain language, which is just conversational, the way that people actually talk so that they're really easy to understand and they need to flow in a way that makes sense to someone filling out the application. And this really matters because if the questions are hard to understand or hard to answer, it's likely that more people will answer incorrectly or submit the wrong answer. Meaning that they might not get the benefit even if they are in fact eligible. And then we also talked a lot about the importance of mobile accessibility. And this is really critical because more and more low-income families are what's called smartphone dependent, which means they don't have internet in their homes, but they do have a smartphone. So, they rely on that smartphone to do things online like fill out applications. But a lot of government websites are not built to fit the smaller screen on a mobile phone. And that makes it really hard for people to do things like fill out online applications for benefit programs. So, it's really important to make sure that the online application is designed to work on a mobile phone because that's how we know most families will be accessing it. I think the application component demonstrates a lot of the sort of thoughtful design work that's going to be required to create a program that's truly accessible for the people that need it.

I'm really appreciative of this. And as I heard you talk about this, especially with mobile devices and I was thinking about younger folks, but I also know that there are grandparents or older adults who will care for young children who may be eligible. What considerations do you make for older adults or people with disabilities that may make using certain devices difficult?

That's a great question. We have done a fair amount of research on this and what we found is that the sort of principles of human-centered design we really need to design for everyone. And that means designing for accessibility or ability, right? Designing for multiple languages, designing for whatever device people have access to, designing for different levels of comfort with technology. I think we really believe in the sort of principle that if you design it for the person that's going to have the most trouble accessing the program, you make it easier for everybody, right? So, we really think about the highest need population and design for that population and then really believe that we sort of make it more accessible for all populations that need to access the program.

This has been really helpful for me to consider how government can work for people by using human-centered design to really move the process of applying and attaining these assets or these benefits, easier for folks. And I'm really grateful to hear the work that you all are doing with Share Our Strength. I got to ask this last question. What are your hopes for Summer EBT in 2024 and even beyond?

I love this question. I have so many, I spent a lot of time so far talking about how hard this program is going to be for states to implement and it will be, I don't want to downplay the significant effort that it's going to take for states to stand up this program and deliver benefits, especially in this first year. That said, in my experience, people who work in government are incredibly resilient and resourceful and they are incredibly creative problem solvers. Pandemic EBT was really hard to implement, and states were trying to figure out how to deliver that program in the first few months of a global pandemic where everything was shut down and there was sort of historic need for benefit programs. But by the time that program ended, every single state had delivered Pandemic EBT benefits to families. So Summer EBT, especially in these first few years of its implementation, will be challenging certainly, but it won't be impossible. States have really proved that they can do this, right? States are good at this. So, I guess my greatest hope is that states are able to address many of the challenges of implementation this year in order to put benefits in the hands of families and that more states opt in, in future years, right? So that eventually all families get to benefit from this program. Ultimately a policy is only as good as its implementation, right? We have to help states design programs that are effective for them to implement, but also that work for the families that they're serving so that the Summer EBT program can live up to the promise outlined in the policy.

Bio

Eleanor Davis is the Program Director for Government Innovation at Code for America. In her role, she enables government agencies to adopt best practices for human-centered digital benefit delivery. She joined Code for America from Futures Without Violence, a national public health and social justice nonprofit dedicated to ending domestic and sexual violence. There she worked for 6 years on the Public Education Campaigns & Programs team, developing public-facing initiatives that support the ability of frontline providers and advocates to more effectively respond to and prevent violence and trauma. Eleanor is a graduate of the University of Chicago where she studied Sociology and Performance Studies, and received a Masters in Public Health from UC Berkeley. Outside of work you can often find her gardening in her backyard or singing in her family band.

In 2022, more than 6 million people visited farmers markets across North Carolina. Today, we're talking with a team of people who are the driving force behind the North Carolina Farmers Market Network: Maggie Funkhouser, Catherine Elkins, and Nora Rodli. The goal of the North Carolina Farmers Market is to create and support a thriving network of marketplaces for the state's local food and farm products. The nonprofit network, which was recently awarded a USDA Farmers Market Promotion Capacity-building grant, will provide education, programming, and partnership development assistance to farmers market managers, including resources to support historically underserved populations.

Interview Summary

I would like to take a moment to actually get to know you all a little bit better. Tell us a little bit about how you got involved in farmers markets. Catherine, let's start with you.

Catherine - Sure. I've been doing this for the longest, I suppose. I went with my mom many times to Amish markets in Pennsylvania where I grew up. She was not a very good gardener. But we could buy everything that she liked at the market. I also worked a bit at the Carrboro Farmers Market, and I then got an opportunity to work with the Morehead City Saturday Market, a one-year lifespan. And the Old Beaufort Farmers Market we started up the next year, that's now in its 10th year. That makes me proud. I liked that market a lot. Managed it for two years, and I'm still one of those devotees that go on vacation and have to look up the closest farmers market just to check out new stuff.

Maggie - Like most managers, I did not go to school to be a farmers market manager. It kind of found me, I guess you could say. I went to graduate school directly after undergrad for classical languages. Then when I moved back to the Triangle, I just sort of started getting involved more and more with local food. I worked in restaurants, I worked in coffee shops, and one time I worked in an artisan bakery; I managed a culinary garden, and I just kind of kept getting drawn into different parts of the community in our local food system in the Triangle. In 2019, I applied for and was offered a job at the Carrboro Farmers Market as the assistant manager. I worked there for about a year. Then in 2020, I took over as the manager, and I've been here ever since.

Nora - So, I actually come to farmers markets as a farmer. For the past 25 years, I've farmed in various places around the country, mostly New Mexico and Hawaii and now North Carolina. That has given me the ability to see and experience farmers markets in a lot of different manners, whether it be a small market or a large market, and urban versus rural settings. I feel like I am uniquely on board as a cheering squad for farmers markets.

Thank you. We all need a cheerleader on our side, so it's good to hear that. I really would love to ask each of you more questions about your past because there are some interesting connections that I hear. Catherine, the Marine Lab is in Beaufort, and I'm intrigued to know more about how those relationships develop. Maggie, I would love to talk more about your training as someone in the classics has influenced the way you think about this. I mean, this idea of food and agriculture is deeply within that literature, and so that's really fascinating. And, Nora, I just can't wait to learn more about Hawaii. But I can't do that right now. We have other things to focus on. However, if those answers come up in your other responses, please feel free. I'm intrigued to talk to you all a little bit more about the North Carolina Farmers Market Network. What is it and who does it serve?

Maggie - I'll kind of kick us off talking about the network a little bit, and maybe my colleagues can chime in. So, we incorporated this year as a 501 nonprofit under the name North Carolina Farmers Market Network. NCFMN, for short. That's our kind of alphabet-soup title that I might say really, really fast. But there had kind of been plans and thoughts to form a statewide network in North Carolina for a long time. We gained a lot of momentum in 2020 because in 2020 we started, with the help of the Carolina Farm Stewardship Association, the State Extension and RAFI, when the pandemic hit, we started having these weekly Zoom calls that were specifically for farmers market managers. The reason we started them in March 2020 was because we were all really, really unsure about what was happening and what was going to happen to the farmers market spaces. Many of our markets across the state were shut down. Many of them had a lot of additional regulations and policies and emergency protocols that were really hard to implement, especially if there were no permanent staff or volunteer staff or part-time staff. In my position, I'm lucky enough to be full-time, but many market managers are not. So, we started out as a rag-tag group of market managers that were just trying to stay open and operating in a really difficult time. We had weekly calls, and we went over different policies we had, different marketing techniques we were using to communicate to the public about our pandemic response. I really clung to it as a source of support during that time. Then over the next couple of years, we started meeting biweekly, then we started meeting monthly. We kind of realized that we had a lot to talk about and a lot to share. Our Zoom name was COVID-19 Calls for Farmers Markets. But what started out as COVID-19 Calls for Farmers Markets turned into resource sharing, professional development, learning things like grant writing, bookkeeping, managing conflicts. And last year we decided to make it official. So, we applied for our FMPP grant, our Farmers Market Promotion Program grant, through the USDA, and we were awarded it. And then we were on the path to nonprofit incorporation.

Maggie, that is really fascinating, and it's interesting to hear how a crisis of COVID-19 drew a lot of you together. Correct me if I'm wrong, but it sounds like it was beneficial in terms of the work you were doing. And it may have also had some personal benefits - just being connected to other people who were in the same field. And you all were able to talk about how you were managing things. Did that take place? Was there more than just sort of, "Here's how to manage your books," or "Here's how to manage conflict"?

Maggie - For sure. The camaraderie was just incredible. Farmers market managers, it's kind of a funny position, and maybe Nora can speak to this a little bit as a farmer who sells at a farmers market, and maybe a different perspective about what a market manager does or the role they occupy. But we do a lot of different things. On any given day we can be planning special events, applying for grants, communicating with vendors, communicating with our boards. And so, to have connections, especially for me being in the Triangle where we have a lot of farmers markets, I had never really met their managers or interacted with them. And now we're total pals. It really was an opportunity for me to share experiences with people who have very similar jobs, and those jobs are often singular in their workplace.

Nora, since she called you out, I'm interested, from a farmer's perspective, I would love to hear your thoughts, and, of course, Catherine, please feel free to join in.

Nora - Yes, I'd love to share. I feel like before meeting this network, and I've only been with them since April, I have to admit that as a farmer, I showed up at the farmers market and thought that's when the market began and didn't really think much beyond who was behind making it happen until I got there. And I've learned and been humbled by how much of an oversight that is. I definitely am guilty of not appreciating all of the work that goes into making sure that farmers markets happen. And I've spent the last six months learning about all the details of things that market managers deal with that farmers have no idea. And it's similar to farmers, maybe, in that way where we wear many hats. And so, I feel like I've learned, one, to appreciate them, but, two, there's not a lot of collective appreciation by anybody that goes on for farmers markets managers. And so, I think that by them grouping together every month because it can be such a siloed experience, it just seems like this really beautiful connection where, when you do your job well as a market manager, there's nothing, like no one says a thing. No complaints mean success. And so, here's a group that can give you compliments, you can empathize with one another, and know that you have each other's back. It's just a beautiful network.

Catherine - I think also what we noticed was that many times the overlap and potentially collaborative nature amongst managers is really great. These are not competitive people. They have secrets to share about what their special events might be, and not everybody has to hold Tomato Day on the same day. Or they may know people at City Hall that are the right people for this kind of permit or may as well share these things. They're all on our same perspective. And plus, that, we found that there were many other states that had networks or associations. So, we could follow them, especially during a period of crisis and near panic as COVID was. Everybody's just glued to their screens looking for information. And the states that had robust networks or associations already in place seemed to be able to help their markets succeed really well.

Thank you all for sharing this. It's really fascinating to learn about the development of this farmers market network and to know that there are other farmers market networks in other states, and it's great to hear of the learnings that you all gained from each other within the state and across states. So, this is really helpful. I've got to ask this question. I mean, it sounds like what drew you all together was the pandemic and thinking about how to navigate policies. Now that, I pray, we're through the hard part of COVID, and I say that cautiously, what are things that are on your agenda now? What do you hope to see be different?

Maggie - Catherine kind of spoke to this. Even though farmers markets are separate spaces, our market is within 20 miles of four other farmers markets. But the goal is not to compete with them. The goal is to lift up farmers markets as accessible community spaces and viable spaces for our farmers to make direct sales. So, for us, we really want to strengthen that local food ethic across the state of North Carolina. Because selling at farmers markets is an extremely viable way that small-scale farmers can succeed in North Carolina. And so, if you have a market manager that is leaving after six months because they're overwhelmed or they haven't received a lot of institutionalized knowledge or training or what have you, then that's where we can step in and say, "We have training, we can give you information, we can share resources, we can provide a network to you." Our big, impactful goal that we're working for is having a statewide nutrition incentive program, and I think Virginia calls theirs Fresh Match. Many statewide organizations have Double Bucks, Fresh Bucks, Market Match, whatever you want to call it, where they provide a dollar-for-dollar match for nutrition incentive programs like SNAP EBT or the Farmers Market Nutrition Program. And as of right now, farmers markets in North Carolina, most of them are fending for themselves. There are a few regional systems like in the western part of the state, the Triangle area farmers markets, Mecklenburg County farmers markets, that are working together. But we really want to have a statewide network where farmers markets across North Carolina can offer nutrition incentives to shopping at farmers markets.

Thank you for that. I'm really happy to hear how you all are working towards addressing policy questions and thinking about who the farmers markets can better serve by using programs like Double Up Bucks or the nutrition incentive programs, and seeing that work across the state. Because there are some significant differences in economic realities across the state. So, that's wonderful to hear you all are doing that work. I'd just like to take a step back, and I'm going to go back to you, Maggie. Can you talk to us about the role of farmers markets in communities? What role do they play?

Maggie - We talk about this a lot in the farmers market space. Because from the outside, farmers markets are spaces of commerce. They're a space where farmers can get together. Maybe you don't realize there's a level of organization behind it. But, in reality, anyone who is a regular at farmers markets knows that they are not just a space of commerce, that they are a community space. They are a third space, and an opportunity to socialize, meet your local farmers. And at our market, we were founded in the late '70's, we have customers who have been coming to our market for decades. They've known some of our farms for years, they've seen them get married and have kids, they've seen their loved ones pass away, they've seen them go through hardships, and seen them go through multiple recessions at this point. It's a really unique space, especially in this kind of era where there is an increasingly globalized economy where you can order one-day shipping for everything you need. To be able to meet the person that's growing your food or baking your bread is really unique. Many farmers markets promote the sense of community, and engagement between consumer and producer. A lot of us offer different types of community programming to kind of bolster that. So, things like kids' activities, encouraging healthy nutrition and things like senior days, educational events. Catherine named Tomato Day, which happens to be a very big day for us. And we've kind of touched on Double Bucks and food access, and that's another real priority for a farmers market. And, also, I didn't mention this when we were talking about the pandemic, but we were looped under grocery stores as essential for the state of North Carolina. And so, that kind of maybe speaks to how we feel, and I hope others in our community feel about farmers markets as well.

Wow, that's really fascinating. I didn't appreciate that farmers markets were treated like grocery stores as essential workers. That's really interesting. I'm intrigued, Nora and Catherine, what about your thoughts about the role that farmers markets may play in communities?

Catherine - Well, Nora would agree with that. The farmers are their own community, and they appreciate the opportunity to meet each other across the aisle, across the tables. "How's things going on your farm?" "Let me tell you about what's happening at my place." Farming can be a really solitary profession. There's many, many hours spent as just one person on a tractor, one person planting seeds, one person weeding. To have the camaraderie and the opportunity to meet up with your peers, that's pretty powerful on a Saturday morning. It is a lot of time sometimes to give up. The better farmers markets, of course, are the ones where you're talking directly to the farmer. How did they prepare this soil, or are they certified naturally grown? What does that mean to them on their farm? You get to actually have that conversation with a client, but only in person. So, it's a big deal for the farmer.

Nora - Yes, for sure. I can speak to that. I feel like most farmers don't have a lot of neighbors close by, and we can feel isolated in our own little work bubbles. And so, a farmers market is the social event of the week for us. Many markets that I have been a part of will have a standing lunch afterwards, and it develops into friendships that are really deep. I also wanted to just mention, from the farmer perspective, the value of meeting customers who are purchasing things from me and my farm, from others and their farms. It's not just meet your farmer, but for us it's like meet your customers. And it's a chance to explain something, like why you're excited about the diversity of such and such crops, why it matters. There's only so much you can put into website descriptions and social media, and it's just two-dimensional. Having the opportunity to meet and share space, the farmers market is so essential, I think, to not only understanding our food and where it comes from and how it's produced, but increasing our value of it in this day where it seems like food is sometimes just an afterthought of convenience.

I love the idea of the farmers market being sort of like the water cooler for farmers to get together and swap stories and share in each other's joys and probably also frustrations and pains. I can imagine how that's a wonderful space for folks. I remember watching a farmers market, I was staying in a hotel, and this is how I can say it. They were there at five in the morning, and I was like, "What's all this noise?" And it was great to see all of these farmers, one, setting up, but then I could see some of those exchanges. I had a sense of like there was a real community there. So, that's wonderful. And this makes it clear that these farmers markets can be really beneficial for farmers. I'm interested to hear a little bit more on how farmers markets are supportive, if at all, to the financial wellbeing of farmers? Or is this just a labor of love? Is it just the water cooler?

Nora - I feel like they're super economically important, and I think where I would say most importantly is as new and beginning farmers who are establishing their businesses. It is an extremely unique place to be able to try out different produce offerings and pricing. It's like you're practicing everything before you're able to have a reputation to secure accounts that might be other versions of direct or indirect marketing. And so, farmers markets offer you that opportunity to gain instant feedback: "Did that sell, yes or no?" "What were the questions?" "What were the gripes?" It gives you constant feedback to be able to refine as you grow your business and make decisions for the coming years. That's not only important as a farmer independently, I was also involved with some farmer-training programs, and we really highlighted farmers markets as giving that opportunity.

That's a great insight, that it's almost like a farmer incubator. It helps farmers test out different marketing means.

Nora - 100%, yes.

I would love to hear from some of the others. Catherine, Maggie, what are your thoughts about the financial benefit of farmers markets?

Catherine - We keep talking about it, how it's so perfect for the farmer or for the producer but think of how perfect it is also for the shopper to keep coming to a place that's always trying to reinvent itself in serving better and better and better food. My local brick-and-mortar store doesn't do that. There are different priorities.

I am an economist. I am just loving this idea of price discovery in the market and the idea that each of these markets are different and they're idiosyncratic and there's something new happening. This is actually worthy of further study, but that's another conversation for another time. So, thank you for sharing.

Catherine - I think you know probably better than most that farming is not a get-rich-quick scheme by any means. There are many examples of people, friends, who are pouring their heart and soul and muscles and fingernails into growing better and better, and they have to love it. They don't usually pay themselves terribly well.

Maggie - Many of our farmers sell at multiple markets, and it's kind of funny to hear things like: "Oh, I can always sell my cucumbers at the Carrboro farmer's market, but I can never sell them at another market." It's so funny to think about how the different farmers markets are literally different economic markets, where our customer base has like their own kind of idiosyncratic interests, and maybe they love persimmons or something like that. At our farmers market, we're definitely an incubator farmers market.

I want to ask one last question. And I say it's last, and we will see how the conversation goes. Because this has been really a delight. For market managers and farmers, what does the North Carolina Farmers Market Network have to offer them? Catherine, why don't you begin?

Catherine - Just like seeing your friendly farmer neighbors in person on Saturday morning, it's also really fun and informational, educational, all those great words, to Zoom with the managers. We have a first Thursday of the month Zoom call to the managers who are members. We have a range of topics prepared. We have space for updates on legislature. We had somebody come in from Senior WIC to help us learn what they're doing for us. How to collect data from your farmers markets is really helpful for boards and municipalities and us as the network. We're going to be asking for data. How to send out a census. What's everybody doing for the kids programs that's new, haven’t been tried before? So, that Thursday morning event has a good deal of value, we think. We also have a connection to Farmers Market Network, and we'll be able to offer discounts on insurances, I believe, as well as membership and access to their resource library, which is immense. We also wanted to make sure you knew that we were seeing other states like Virginia teach their managers best practices and have a market-management certificate, something we hope we can offer someday. We certainly will be hosting regional meetings to get to know the managers better. We have five regions around North Carolina. That'll be pretty educational. That'll have a program for it.

Nora - I would love to add to Catherine's description that in addition to being a place where farmers market managers come together, we're also a network that invites others who work in the food system and who are passionate about the same issues to become members. They're valuable voices to include in every conversation. For example, just the other week I sent out something, kind of a newsletter. I had some questions that market managers had been asking me about food-safety regulation issues for farmers markets, which comes up a lot. And in the responses, others who worked with NC State or Extension roles, piping in saying, "I have a good resource for that," or "Here's the answer." And I feel like the value of bringing together all these voices in the same room is huge.

Maggie - I love all of what Catherine and Nora were saying. You know, it occurs to me also that there are over 200 farmers markets in North Carolina. Supporting farmers markets is part of supporting North Carolina's agricultural fabric. It's part of supporting small-scale family farms, organic farms, spray-free farms. So, I think that if we can assist with marketing those farms and farmers markets, that feels very important and impactful to me. And then I also want to draw us back to education for larger stakeholders and maybe government organizations about some of our statewide initiatives like Double Bucks. I think that's where we can really offer a collective kind of impact, where maybe individual farmers markets don't have the capacity to work with larger stakeholders, but as a network we can come together and we can really have a much broader impact.

Bios

Maggie Funkhouser is currently serving as the interim Board Chair of the North Carolina Farmers Market Network. She is the Manager of the Carrboro Farmers’ Market in Carrboro, NC, where she has worked since 2019. She was raised in North Carolina’s Triangle and has worked in local food systems there for many years, including as an educator, gardener, baker, and foodservice industry worker before coming to the farmers market. She carries with her a love of writing, language, and storytelling from her classical education background, and she is drawn to foodways stories and oral histories. She is especially interested in the intersection of food access and farmers markets, as well as learning more about making farmers’ markets inclusive, equitable, and accessible community spaces. 

Catherine Elkins has long enjoyed the spirit and joy of farmers markets, starting in Pennsylvania visiting several Amish markets and continuing in North Carolina after moving to Chapel Hill. She volunteered for many years at the Carrboro Farmers' Market, and then after retirement, stole many of their successful strategies when designing, starting and managing the Olde Beaufort Farmers' Market. She also assists with the Carteret Local Food Network's Mobile Market which operates a red short school bus tricked out to serve many low income and senior communities in Carteret County with the freshest, most local produce and farm products from Carteret farmers.

Nora Rodli is the Program Coordinator for the NC Farmers Market Network.  She brings over 25 years of agricultural experience from working as a farmer and with farmer training and education.  She also has a healthcare background as an advanced public health nurse (APHN).  Currently living and farming in Boone, NC, Nora is passionate about the primary roles that local food and increased access to local food can play in health promotion and disease prevention, resilient local food systems and vibrant inclusive communities.

It has been said many times that a picture is worth a thousand words. Our guest today is documentary photographer Sally Thomson, the creative genius behind the book "Homeground." She hopes her photos of 24 ranchers and land managers can broaden people's understanding of the impact conservation ranching has on the health of the land, the animals, and the people who live, work, and recreate in Southwestern and Rocky Mountain rangelands. Her book also includes rancher quotes and essays from land managers working to address challenges of climate change and diminishing resources and to find sustainable land management solutions.

Interview Summary

I was especially interested in doing this podcast because we've had a lot of people on to talk about regenerative agriculture and there have been farmers and ranchers, some of whom we both know in common. There have been scientists who work on this, people who work with NGOs trying to promote this work, and even some policy makers, but never a photographer. It's going to be really interesting to hear from you and I look forward to what you have to say. So, we have spoken to chefs and filmmakers before who've used their arts to shape and change the food system. But as I say, you're the first photographer we've spoken to. Let's go back to the beginning. What got you interested in photography in the first place, and how can photography be used as a social or political statement?

Well, I didn't start out to become a photographer. I took a art class in college and that is really what first introduced me to photography. I was gifted a used cannon camera and a couple of lenses and I started experimenting with the camera. And I was immediately drawn to the medium. Especially watching the images kind of emerge in the dark room was just fascinating and kind of magical. But it never really occurred to me to consider photography as a career. I eventually went on to graduate school and I studied landscape architecture following my interest in environmental design and planning. I figured this would also give me the opportunity to incorporate photography into my creative process. I practiced landscape architecture for many years. But it wasn't until much later that I realized the power photography can have in storytelling, and raising awareness, and connecting me with people in places that, you know, I wouldn't have otherwise thought possible. So, up until about this point, I had used photography more for documenting my work. I had worked for a conservation organization in the Amazon Rainforest, and in order to communicate their message, I felt that photography was extremely useful in doing that. That's really what caused that shift in my thinking of turning to photography. In 2008, I created On Focus Photography, which was an effort to highlight the work of various underrepresented environmental cultural NGOs. I set about trying to learn everything I could about documentary photography at that point. That sort of led me to where I am today. What I do today is primarily divide my time between freelance assignment work, fine art and documentary photography.

Thanks for that background. It's really helpful to understand how you got to where you are now. So, let's turn to your book, "Homeground" brand new. Can you provide an overview of the book and what are some of the key things that you're hoping to convey?

Well, Homeground, of course, is a visual narrative. It explores the endangered rangelands of the American Southwest and the Rocky Mountains, and the people and the practices that are involved in restoring and sustaining these landscapes. I think one of the things that was kind of startling to me was the account of our rangelands, and I just wanted to talk about that briefly. Rangelands account for the largest share of the nation's land base. They cover more than one third of the land service in the continental US and that's according to USDA data. Unlike pastureland, rangelands consist of native vegetation, and they include a wide variety of different landscape types such as grasslands, desert shrub lands, and so on. They provide essential habitats for all kinds of living creatures, forage for livestock, and recreational opportunities. But in this country and elsewhere around the world, I learned that these lands are threatened due to land conversion, unmanaged grazing, invasive species, climate change, and things like that. The Nature Conservancy, in fact, says that grasslands represent the most threatened and least protected habitat on earth. Less than 2% worldwide and just 4% in the United States receive any kind of formal protection.

So, thinking about the Southwest and the Rocky Mountains, as you probably know, they connect vast areas of habitat and there are all kinds of organizations, federal, state, private and tribal ownership that form this mosaic of pattern on the land. But private individuals own more than half of the nation's range lands. The federal government manages about 40%, and state and local governments and tribal councils manage the remainder. I found these numbers were rather compelling, and it sort of put, for me, into perspective not only the scale and significance of these landscapes but point to the important role private land managers play in caring for this huge amount of land in our country.

There's a lot at stake, isn't there? Given how much land you're talking about and the importance of it to environment and everything else.

It is. And there's a map in the book that shows that distribution. It was based on data collected by USDA, but it was interpreted by Dave Merrill, who works for Bloomberg. It's just very insightful when you see that big square of rangeland and you realize how much landmass that really is. So, that really struck me and I wanted to make sure that people understood that.

Let's get back to the themes of your book, because I'm dying to hear about them. But tell me first, what inspired you to take on the issue of regenerative agriculture in particular?

I've always been deeply interested in the relationship between people and environment, and sort of how our actions can shape and impact the landscapes that we live in. When I moved to New Mexico in 2013, I'm originally from the East and went to school in North Carolina as a matter of fact. I got a job helping a local nonprofit organization called the Southwest Grassfed Livestock Alliance here in Santa Fe, SWGLA for short. I helped them to produce a short video about how some producers were beginning to manage their animals on the land by utilizing a method called Holistic Planned Grazing. This was a term first introduced by Alan Savory, decades earlier. So, for this project, I visited six ranches spread across the states of New Mexico, and Colorado and Arizona. Traveled all around interviewing these ranchers. And through that experience, I grew a deep appreciation for these people, the men and women who managed these vast and often very remote tracks of land, and their dedication to regenerating some of the most incredible degraded landscapes that I've seen. I was inspired by their dedication and their determination, and I continued to visit and photograph over the years dozens of ranches and others who worked toward improving the ecological health of our rangelands. I guess you could say that the book "Homeground" was my pandemic project because I'd always wanted to find a way to share these images and the information that I had accumulated over the years. The lockdown kind of gave me time to sit down and think about how to organize and present what I had learned. So, around 2021, I decided that I was going to create this book and it would be titled "Homeground." Home alluding to a place of belonging and identity relating to the land. This seemed appropriate for me and the way of life that I wanted to feature.

Sally, you mentioned Alan Savory and I wanted to make a note to remind our listeners that we've recorded a podcast with Alan Savory that's part of our series on regenerative agriculture. And, the person who connected the two of us, Nancy Ranney, a rancher in New Mexico, and I know somebody you know well also has been a guest for part of our podcast series, both very impressive people. So, now let's talk a little bit more about the book and some of the choices you made in producing it. Some of the book's photographs are in black and white and some are in color, that's an interesting choice you've made. Can you share some insights about the process of selecting and capturing images, why you did some in color, some in black and white, and how did these reflect the principles of regenerative ranching?

I've had a few exhibitions that revolve around this work, and most of those were all done in black and white. When I started putting the book together, I felt because you're up close and personal looking at these images, that color would be good in moving you along the story. Also, some of the images were old, some were taken back in 2013, some were taken in 2022 and 2023. So, it was sort of a way to differentiate the flow of the work. Along with the images, there are three essays in the book that are written by well-known land managers in the region. Nancy Rainey provided one of the essays on community engagement, Bob Budd, who works in Wyoming, and Tony Berg, who has also worked in Wyoming but is now in Oregon, and he's a mentor with the Savory Institute. Each of them provided insightful personal accounts of their experiences in regenerative ranching, highlighting themes of the book, which are the importance of rangeland biodiversity, healthy soils, and community engagement. Ranchers also have some quotations in the book, but I worked quite closely with various state federal agencies and local nonprofits and academic institutions, and there's a lot happening out there in terms of all these other people that are involved in helping ranchers to manage their lands more sustainably. So, some of those are like the Covera Coalition, the Western Landowners Alliance, Holistic Management International, and of course Alan Savory Institute. It's a very complex and interesting world that is evolving and growing, fortunately.

Well, that's so true. I mean, if you go back just a few years even, there's a lot less knowledge about these sorts of approaches to ranching and agriculture, and now a lot more people are talking about it, thinking about it, studying it, writing about it, and photographing it, which is really wonderful. You mentioned that the work took place over a period of 10 years. Are there any specific stories or experiences from this journey you had that you found particularly impactful or enlightening?

Every time I set foot on a ranch, it was impactful. And it's hard to separate out just one story, but one of the most interesting experiences, I think we talk a lot about holistic grazing and how it tries to mimic the bison that roamed hundreds of years ago on the land. I had an opportunity to go out and visit one of Ted Turner's ranches in Central New Mexico where they were having a bison roundup. I rode out into this landscape, which was like actually transporting myself back 200 years where there were no cars, no telephone poles, just the land and the animals. It was pretty fascinating to see those bison, 500 of them roaming across the landscape. When I was out there also, there was a herd of antelopes and another herd of elk. So, I really felt privileged to be out on that land and to witness, almost like stepping back into history.

There are a lot of young people now that are getting involved, which is really great because there was a time when it seemed like people talked about ranching dying. And there have been organizations like the Covera Coalition that have really worked hard to get young people involved in now there's a lot of interest. And not just amongst doing ranching work, but also in the scientific and academic communities. And so, I was able to work with some scientists from the University of Colorado and they were working in robotics of all things, using these robots to monitor the ground and collect data on the temperature of the soil, the composite of the soil, all sorts of things.

Another ranch I went to in Lamar, Colorado, they had reintroduced the black-footed ferret, an endangered species, that almost went extinct in the 1980s and they were bringing back to, you know, regenerate the soil in that part of the country. So, I actually went out with a team of scientists at night because they're nocturnal animals and the only time you can see them and that they can figure out what they're doing and where they're living, and how they're living is to spot them at night. They ride around from maybe 10 or 11 o'clock at night until the early hours of the morning searching for these black-footed ferrets. They'll stick their heads up out of a hole in the ground, but they're determined. And that determination and that interest was really exciting to see.

You paint a wonderful picture of all this when you were talking about the bison and being transported 200 years in the past created this very vivid image in my mind, and I can imagine how powerful it must have been to be there and how wonderful it is that you've captured this in your photographs. It is just so important that this kind of work gets communicated. One of the reasons I'm delighted that you did your book. Let me ask you a final question. How do you envision your book contributing to the broader conversation about regenerative agriculture and ranching, and the sustainable use of land, and what do you hope readers will take away?

I think the book provides a broad understanding to a very complex issue. Sometimes those issues are difficult to understand because they're wound up in a lot of statistics, or the media is not reporting accurately, or even reporting at all on the issue. I'm hoping that a book like this that shows photographs will draw people in to want to understand more. The other thing I wanted to mention was that these land managers that I have met, they understand that ranching and healthy systems go hand in hand, and making the regenerative transition is a slow, and it's a complex process. There are no quick fixes, there's no one size fits all answers. And that's most likely true, I would say, for anyone, anywhere who's trying to make that regenerative switch. In our fast-paced world, it seems like that nothing is happening, but it just takes time. That's one thing that I can see over this 10-year period is I can see a change. That's pretty gratifying.

Grasslands in particular are very overlooked ecosystem in our country, but they play a crucial role in guarding against climate change. And one thing that amazed me was that a three-foot-tall grassland plant has a root system that extends more than three to four times below the surface of the earth. And those deep roots work to stabilize and they nourish the soil and can sequester huge amounts of carbon from the atmosphere. So, rangelands are important in that way, and I think it's important for people to understand about that. Another thing is that I think our Southwestern and Rocky Mountain Rangelands, they're a part of our collective history and legacy, and their landscapes that provide us all with clean water and clean air. They offer us respite and recreational opportunities. And in our world now where 80% of the population resides in urban areas, it's pretty easy for us to overlook what we don't encounter every day. It's my hope that "Homeground" will engage viewers from across the country to consider the significance of regenerative ranching and its potential benefits to all of us regarding climate and conservation, wildlife, and food production.

Well, what an important goal. So good luck looking forward. So, for people who are listening, who'd like to obtain a copy of the book, how should they go about doing that?

They can go onto my website: sallythomsonphotography.com.

Bio

Sally Thomson is a documentary and fine art photographer based in Santa Fe, New Mexico. Her work explores the relationship between nature and culture and how that forms our perception and expression of where and how we live. Thomson's previous experiences in landscape architecture and conservation planning inform her work as a photographer, which aims to inspire the conservation and regeneration of endangered environments and the cultural legacies they support. She holds a Master of Landscape Architecture from North Carolina State University School of Design. She is the Past President (2017-2021) of the American Society of Media Photographers New Mexico Board of Directors.

Our guest today is Jasmine Crowe-Houston, social entrepreneur, and founder of Goodr.co. Jasmine started her journey cooking soul food for hungry unhoused people in her kitchen in her one-bedroom apartment in Atlanta. She fed upwards of 500 people a week for years with pop-up kitchens and parks and parking lots. Then in 2017, she founded Goodr, a technology-based food waste management company that connects firms with food surpluses to nonprofit organizations that can use the food. She has worked with organizations that have food waste issues, such as the Atlanta International Airport, Hormel Foods, and Turner Broadcasting. Today, Goodr has expanded nationwide and sponsors free grocery stores and schools. She has combined charity, innovation, and market-based solutions into a for-profit waste management company that Inc. Magazine called a rare triple win. 

This episode is in collaboration with Policy360, a podcast of the Sanford School of Public Policy at Duke University.

Interview Summary

Would you describe what Goodr is today?

Goodr is a blessing. We are a sustainable food waste management company that leverages technology to connect businesses that have excess food to non-profit organizations that can use that food. And at the same time, we have a line of business, which is Hunger Solutions, and we're helping brands and government and other municipalities rethink how hunger is solved in their communities. We believe that hunger is not an issue of scarcity. It's really a matter of logistics. And so, we are using technology and logistics to drive out hunger and food waste. We've built technology that includes our mobile app and portal. Imagine you are using an Uber Eats or DoorDash app. You go onto your favorite restaurant; you click the item that you want. Similar experience for our users. So, for example, a restaurant in the airport. Their menu is in our system. They click chicken sandwich; they tell us 50. Our platform is going to calculate the tax value of those sandwiches, the approximate weight of those sandwiches, and our algorithm is automatically matching those sandwiches with the non-profit that is serving 50 or more people that can take those items and then get it distributed to people in need. Another big thing that our technology is capturing is the poundage that we're keeping out a landfill. So, it's really important because we're able to tell our clients we have kept 2 million pounds of food from landfills. This is equal to this much CO2 emissions that you've helped to prevent. We do a lot of fun gamifications as well, but we're data-driven and we believe that you can't manage what you don't measure. And for too long, people have thrown everything away. They've never measured it. And now we're giving them real insights and they're seeing things like, wow, my number one wasted thing is pork. Why am I making pork so much? Maybe people here at our offices don't eat pork. Start to make changes. So, we really work on the source reduction, but the number two on the EPA is the food hierarchy chart is feeding hungry people. And so that's really where we are.

Wow, that's amazing. I want to ask because I've seen this in the food waste and food donation world, that sometimes food that's donated isn't appropriate or fit for human consumption. What happens to those food products?

Traditionally, they end up in landfills. One of the big things that we have to do at Goodr, and I'll tell you too, that change is by county. So, think of not by city, not by state. Wake County and Durham County probably have different rules because it's based off the health department in each city. So, a good example is when we were working in Florida, what we do in Miami is absolutely illegal in Fort Lauderdale. They're 10 minutes away from each other. Broward County and Dade County have different rules. So, we spend a lot of time, our R&D team, creating quality assurance checklists. And we know this food is going to live for three hours. So, you've got to get this either cooled, frozen, or donated within three hours. So, we tell our businesses that. We are moving food in an average of about 30 minutes from the time it gets picked up. Some of our customers will put in their pickup requests and ask that it's picked up the next morning. So, they're going to automatically put it in their refrigerator. That's their comfort level. They feel a lot better. It makes the food last longer and they don't always have to worry about it being fresh. A lot of the time when we're dealing with weddings, really big events, that's when we have to move right away because maybe that business doesn't have access to the kitchen the next day. And so, we need to move a little bit differently. Most of the time when a business has food that's passed that timeframe, they typically do throw it away. But what we've done is we've introduced organics recycling into our fold. So, our customers now have the ability to send that to an animal farm. We can also send it to an anaerobic digester and turn it into an organic product, or we can compost it. We're still keeping it out of landfill. It doesn't have to end up in landfill ever. That's the positive.

Yeah, that's amazing. I saw your 2019 Ted women talk entitled "What We're Getting Wrong in The Fight to End Hunger". And it has been viewed by more than 2.2 million times.

Wow. Yeah, it's so good. I didn't know if you gave me those last million, but that's good to know.

Good job! No, it was over that by the time I got to it, but it's really amazing and I'm just intrigued to get your opinion about why do you think people are interested in solving hunger and food waste?

I think people are questioning why it hasn't been solved yet. It's almost like it's not as big as cancer, right? But it's as big as cancer. Cancer's big, it kills people, right? But we spend a lot of money and there's a lot of research and we feel like we're getting closer to the fight. I don't know if people feel that we're getting closer to the fight as it relates to hunger. And if you think about it, Norbert, when me and you were kids, we probably did a canned food drive. Anybody that's listening right now is probably thinking, "I did some kind of a food drive when I was in elementary school to solve hunger in our communities." Why are we still doing that? Why are we still doing the same things? I always look at it as being the definition of insanity, right? Doing the same thing over and over again and expecting a different result. I think that's what people are interested in. What are we getting wrong? Why is my kid, 35 years later, why am I still doing canned food drives for my kindergarten kid and this is something that I did in kindergarten? And is this moving the needle? Is this really working? People want to know that. People want to know are we pacifying problems or is the money that we're putting behind these actually driving solutions and should we look at something else that's different? Even with my TED Talk, I remember the first week it came out, we got a lot of, "Oh, you're talking negatively about food banks, and they do great work and I volunteer at the food bank every weekend." There's a whole section in my TED Talk where I say food banks and food pantries are vital. They play a pivotal role, but they don't solve hunger alone, and we need to be open to doing new things. We're using technology in every other area of our lives. I mean, we're getting our groceries delivered, we're meeting our spouses, we're going to college. Why are we not using technology to try and solve a big problem like hunger and food waste? And so, it's just getting people open. I think that's what people are interested in finding a solution.

I'm really intrigued by the model of Goodr, the fact that it is a for-profit company. What's also interesting is given all the success that you've had up to this point, it's hard to believe now that investors hesitated to support you.

Yeah, shame on those investors, I would say. I'll tell you, Norbert, the sad thing is, right, any woman listening should know this. Women as a whole get 2% of all venture capital funding from investors as a whole. So, you take a pie and then you take 2%, and now of that 2%, you have women that are Asian, women that are Black, women that are Hispanic, women that are White. We're all taking a piece of that small 2%. So, there's part of that. I think another thing is it's hard to sometimes get conviction around that, which you don't understand. And a lot of investors, quite frankly, have never been hungry, you know? They don't really understand food waste. It's probably not... It's not AI, it's not blockchain, it's not crypto. It's not always in the headlines. It's not the cool thing. So, I think those all played a factor in it. I think that's just the reality. Investors like to invest in things that they can get excited about, and sometimes hunger and food waste just are not exciting. I also think a lot of people felt like this is so good, they should be a nonprofit. And for me, I saw the business case in what we were building right away because businesses were already paying to throw food away. That's the simple thing about it. So why would I create a nonprofit and must ask everyday people to donate so that we can get this food picked up, have to rely on volunteers that may or may not come, which possibly would cause more food to go to waste. Because if you're being paid to pick something up, you're being paid to do something, you're 99% more likely to go, right? If you're volunteering and it's raining, you may not go that day. It doesn't matter how much you care about the cause. You may not want to get in your car, you may not like to drive in the rain. Those are the things that happen. And so I also believe that businesses would value what they pay for. So, if you're investing and you're paying in a service to divert your food waste from landfill, you're more likely to make sure that your employees are actually packaging that food, recording it for donations, scheduling pickups, than you would be if it was just a free thing, and it was a nice to do. I think that was kind of like we needed to prove that, and now we've proven. We have world-class customers. We work with... You name some of them. And I mean, we've worked with everybody from the NBA to Google to Oracle, Nike World Headquarters. These are our customers, you know? People have now seen that this works. One of our biggest customers, they sent over a testimonial the other day and it says, "All the other locations are banging down my door to try and get Goodr." People just needed to give it a try. And so now hopefully when we have those investor conversations the next go around, this market's a little crazy, but hopefully we'll have a bit more willingness to give our solution a try. And there have been great investors who have made an investment in what we're doing.

Right. Thank you for sharing that. And we're at a university and we have a lot of young people who are excited about social entrepreneurship. What can you say to them to encourage them along this path?

I could say to them that they are needed. We were talking about my goal of wanting to be a professor one day, and what I want to talk about is social entrepreneurship and this model of being able to do well by doing good. That there is a way to do that in business and that it ultimately works. And we've seen the big companies that I think are pretty keen and they've seen success for are your Warby Parkers, your Patagonias. These are other B Corps, Goodr is a B Corp as well, who are kind of existing. The first model I ever saw of social entrepreneurship was Toms Shoes. They were really popular maybe 15 years ago, maybe not as much now, but there was a point when it was like, I'm going to buy a shoe and give a shoe. Bombas, the sock and undergarment company, the same thing. They're supporting homelessness. You buy a sock, you're giving a sock, you buy a T-shirt, you're giving a T-shirt. People love to do good. And so, these students that are interested in creating ways and solutions to solve some of our biggest problems, are needed now more than ever. I mean, this world is... I read an article the other day talking about all that millennials have lived through. And I was thinking to myself, goodness gracious, I've lived through a lot, two recessions, a couple of wars, a pandemic, just like everything, technology. I mean, that's the reality of it. I don't recall a smart cell phone when I was in high school and college. That was... I think the iPhone came out maybe in 2008, 2009. I graduated college by then. I didn't have that. Facebook wasn't around until 2008. You start to see what's happening to young people now because of social media, their self-esteem, the anxiety. There are so many things that we need people to be addressing because we're creating a lot more technology, but we're also creating a lot more problems, and they need to be solved.

They do. And it is interesting to think about the anxiety that's associated with some of these issues.

Oh yes.

And the fact that Goodr is trying to address food waste, which is a contributor climate change, I mean, you're providing a solution. And this is great and it helps me think that our students can start to think differently about what they can do to help address these issues.

The Project Drawdown, which is pretty much a leading climate solutions organization, they named, in 2022, food waste. Reducing our food waste is number two after fixing our energy grid. Number two thing that we could do to combat climate change is to reduce our food waste. In America, nearly 2% of GDP has been on food we never eat, which is just insane to think about. 2% of everything that we spend is on food we never eat, from production to transportation to the disposal. And so even around the food waste chain, there's still a lot more solutions that are needed. So even if that's going to be what we're producing at the farm level, what's going to waste? What can we do with it? Can we reuse it? Can we turn things into other products? I was reading an article recently about there's a new kind of leather that's going to be... It's already kind of on some runways, but it's made out of banana peels. That’s a social entrepreneur that thought of that.

I love the fact that you're so welcoming and you're trying to bring people in. And that brings up the book that you've published recently, "Everybody Eats," and it's there to inspire young people in the fight against hunger. It is beautiful. And I see my daughter in this text and so I'm really appreciative of it. And it was illustrated by Nadia Fisher. And there is also a website with resources for parents and kids and teachers. What do you want to accomplish with this outreach effort?

I am often asked, will I solve hunger in my lifetime? I want to say yes, but I have to think possibly not. Hunger grows every single year. I mean, there's a new study I just was reading that it was in the Washington Post two days ago. It's increased 12%. Childhood poverty is up 20%. So sometimes I'm going, or you make the shot, we're at Duke, right? This is a basketball place. So, you make this shot and you can't keep your hand there because the team is already down, the other team's already on the other side of the court. That's often how I feel about hunger. It's like I do something that's really good. It's monumental. We've got grocery stores in schools, we're feeding students, and then I read that childhood poverty is up 20%. How do I leave a legacy that really focuses on solving hunger? I need to inform the next generation and I need to do it in a way, and how I wrote that book is really my story in the eyes of a kid. Me learning that one of my friends, my college roommate did not have food in her household, and that shaping my whole life. And now thinking like your daughter, what would she come back and tell you if she learned that a friend of hers at school doesn't have food in her kitchen like you have food in your kitchen? And they ask questions, and they want to understand that. She goes on this journey asking grocery stores and her school like, "Hey, what's going on with this food? People are going hungry. My friend at school doesn't have access to food," and she's trying to help her friend. And the reality is just like with my friend and the young protagonist in the book, her father just lost the job. I mean, so many people read these stories. I think the most recent article I saw said something like 75% of Americans are living... Are one paycheck away, just one paycheck away. And to see that, that happened to my friend, and it's the most jarring thing that has ever happened to me, probably in life. Because I had a completely different picture in my mind of what hunger looked like until that happened to me. And this happened to me probably three years into feeding people that were experiencing homelessness on the street. I've been feeding people for over a decade of my life. To learn that someone who had volunteered with me, someone who had been out feeding people with me, that they too wouldn't have food in their home, it changed my whole life and my life story. I use all the proceeds from the book to fund a Neighborhood Eats program where I feed kids on the weekends, and I know that I'm making an impact in the lives of children. And they will. My hope is in 15, 20 years, you'll be sitting here talking to someone else who's doing something around this. That's the goal.

You've touched on this, but I just want to push it a little bit further. Food waste and hunger are longstanding challenges and they touch people all along the supply chain. How do you manage the complexity of this problem?

Yeah, I think we have to continue to focus on the verticals that we're really good at because it is big. You'll probably think I'm lying to you, Norbert. I may get a hundred phone calls and emails a week. "Hey, we need Goodr here. We want it... How can I bring this here? Can I bring this to my community? I need food. My senior home needs food. The trailer park that we live in, a lot of us are... It's rural. We're not near a grocery store." I look at myself as trying... I think it's like hero overload. I'm trying to solve all this. How do I get to Canada? Oh, someone just called me from Denmark. How do we go to Denmark? How do we get here? I think what I have to really focus on is US first. I do really well with large scale venues, colleges and universities, enterprise corporate cafeterias, stadiums and arenas, airports, convention centers, places where there's a lot of food in one location. A lot of people wonder, why don't you go to small restaurants? We get calls from, "Hey, we have a deli in Long Island, New York," And we're like, "Hey, we're not there yet, but here's our resource guide for how you can donate food. Here's organizations that you can look for in your community. Here are ways you can create your own food donation programs." We try and give them resources to still solve the problem while realizing that we can't do it all ourselves. And I could tell you as an entrepreneur and as a social entrepreneur, that's the hardest thing ever. Because at first, when I first started Goodr, I'm very happy people in Canada didn't call me then because I probably would've been from Atlanta to Vancouver, and just missing a whole other part of the process. But you've got to follow the process and you've got to get really good at something and then drill in and just become the best at it. The best in class. And that's what we... When we have our all-hands meetings and our team retreats, we talk about what are we the best at? And we also say are there things that we're doing that we're not good at? And to your point, that's why I said I'm inviting other people in, right? Because I know that there's other use cases. We don't work with grocery stores. That's something that's really fascinating to a lot of people. I spent probably the first six months of customer discovery, when I was really trying to figure out who are going to be the Goodr customers that we're going to pitch to of working with trying to work with grocery stores. And what I learned is the two largest grocers in the country created and kind of funded Feeding America. There's a strong system there. I was like, okay, they've got that. Now I'm still trying to work with them on prepared foods. That's my hope with the grocery stores now is those rotisserie chickens, those are the things that don't get donated and so that's what we're really trying to focus on. But the shelf stable things, the produce items, they have a strong solution for that. And it took me six months of trying and hitting roadblocks to see that sometimes people don't want to change what they feel like they've focused on. I had to go and say, okay, well where's the food not going? Where's it missing? And I realized it was prepared foods. And that's why I'm really trying to stay on those rotisserie chickens at these grocery stores, because I think if a parent can get a rotisserie chicken, you could pull some other things together. The meat is kind of what you really need.

So how do you stay inspired?

I try and keep my eye on the prize. I got an email from a lady and her name was Bertha, so I've assumed that she was a senior. Her email said to me, Norman, "I just want to thank you guys for your food today. When I got home, my meat wasn't brown. It was fresh and everything was good. And it came from good stores, I could tell it was quality." And I'll never forget that because I thought just imagine, she's saying I got meat that's fresh. That's her thing. I'm hungry. I'm getting food from your organization and it's good, and I'm shocked by that. So shocked that I needed to send an email to say, "Hey, when I got home today, you gave me something that was good." So that's the stuff that I think keeps me going. I got another email from a lady; this is when we were doing a lot of work. We did a ton of work around hunger during the pandemic if you can imagine. And her email was just like, "I was sitting on my porch, my kids were sleeping, they were napping. And my only thought was what am I going to feed these kids when they wake up? because they're going to wake up hungry. Kids ask me for snacks. We're running low, we don't have anything. And I get a call from a driver named Jarvis who says, 'I'm around the corner. This is Goodr. I've got this food delivery.' And not only did he bring a box of food for my family, but he also brought me a pizza that was warm." because we had... I think Papa John's at the time was giving us pizzas, this is heavy in the heat of the pandemic, to deliver boxes of food that we were bringing to families. And she was just like, "This was a godsend." And she said that we gave her hope in her darkest hour, and I'll never forget that. Those are two emails, and I think both of those emails are from 2020, 2021, that still are in my head today. I think about that as a guiding light to continue to keep going and just knowing that we are really making change.

Bio

Jasmine Crowe-Houston is the creator of Goodr, a tech-enabled sustainable food waste management company that strives to eliminate hunger and save food from landfills. Through her years of work feeding vulnerable populations, Jasmine saw a great opportunity for technology to solve a real problem: hunger. In January 2017, Jasmine founded Goodr, a food management platform that allows users in the food industry to track and redirect surplus food. She's a proud alumna of North Carolina Central University. A resident of Atlanta, Georgia, she enjoys spending time with her family and friends and being a new mom to her daughter Journey. She is an avid traveler who has visited more than 30 countries. Jasmine sits on several nonprofit boards and continues to use her time for good. She was named by Entrepreneur Magazine as one of the top 100 influential female founders and recognized on the Black Enterprise 40 Under 40 List.

Today's podcast is a gastronomic treat. I'm talking with Chef William Dissen, James Beard Award-winning chef and owner of the restaurant, The Marketplace, located in Asheville, North Carolina. William is the founder of four award winning restaurants and draws inspiration from traveling the world, creating dishes that tell a story, surprising guests with inventive food preservation techniques, and bringing classic dishes with explosive flavors to life. He published a debut cookbook in 2024 titled Thoughtful Cooking - Recipes Rooted in the New South. Food and Wine Magazine recognized it as the best spring cookbook and praised how he takes readers on a culinary journey organized by the four seasons of Appalachia's most sought-after ingredients. William also enjoys the fame of being the first and only chef to beat Gordon Ramsay in a cook off on NatGeo TV’s Gordon Ramsay Uncharted Smoky Mountains.

Interview Summary

Will, you were early to the farm to table local foods concept. Some years ago, when I dined at your restaurant, the Marketplace, I liked the philosophy, not to mention the food, would you please tell us what led you down this road?

You know, I'm originally from West Virginia, from the Appalachian Mountains, and my grandparents were, were farmers that lived in very rural parts of the state. I grew up in suburbia in the capital of Charleston, West Virginia, but spent a lot of my weekends on their farm. And they very much lived the Appalachian mentality and culture of farming, of putting things up for the year. You know, they canned and pickled and preserved and fermented and dehydrated, and they foraged and they had honeybees to pollinate their garden. They irrigated with fresh spring water and things that I think now in 2024, hipster DIY trends that people are saying they're doing in bigger cities. But these are things my grandparents were doing to sustain themselves. And I'd say that those ideas and ideals imprinted upon me about not just sustainability and how to treat the earth, but also about how to make food delicious because great food starts fresh.

And from this initial exposure to food customs of your youth what led you to being a chef?

You know I think in those hot sweaty August days, as they say up in the holler of my grandparents’ farm, we'd sit in the front porch and shuck corn and string beans. I really kind of kindled a love affair with food. One of my first jobs I had, I was a newspaper delivery boy and shortly after that I was, you know, trying to hustle to make some more money. And I ended up washing dishes at a local country club. And I think a very similar story for a lot of chefs, one day the garde manger cook or the salad and sandwich cook called out. And the chef said can you make sandwiches and salads? And I thought, sure, I can do that. And haven't really looked back since.

You've been a chef at many fine restaurants in major cities. What led you to Asheville, North Carolina in particular?

After I left West Virginia, I lived all over the place. I was in New York and California and South Carolina and ended up back here where I'm now in Asheville where I have my restaurant, The Marketplace. And one of the things that really stood out to me was the really beautiful region. National Geographic has voted it time and time again as one of the most biodiverse places on the planet. It's actually a temperate rainforest. There are species of wild edible greens and medicinal greens. There are species of lizards and snakes and things that you only find here in this region. It's not just beautiful. It's also a really thriving ecosystem.

Terms like intentional, mindful, and in your case, thoughtful - it's in the title of your book - can be applied to cooking and eating. What does it mean to you?

I'd say in general, it's going back to what I mentioned about my grandparents. And really focusing on being present but also planning ahead. I feel like in this day and age, we're so connected to computers and phones and social media that we've kind of got disconnected from our food system. People say, well, you know, technology is driving the world and we need to be logged in to be able to stay relevant. And I don't disagree with that, but I feel as our society is doing that, we are losing touch with nature. And if you go back one generation, two generations and ask anyone, their grandparents, I'm sure grew a garden. Or were farmers, and they probably went through acts of preservation because there weren't Whole Foods in every corner. It wasn't Amazon delivery. They had to plan ahead, and to be in touch with the time of year enables them to sustain themselves and their families. And certainly, we're fortunate now in 2024 to not have to think that way all the time, but I do think there's a lot of value into being a little more thoughtful about the world around us.

And I think that's really what I want to try to show people with my book, Thoughtful Cooking, is that connecting yourself to the food system enables us to connect ourselves to the environment. Enables to connect ourselves to our local economy, to our community, and to be reconnected with those that make our food. And I think that's an important thing that a lot of us are missing in this day and age.

Please tell us more. What does thoughtful cooking look like in action?

I think thoughtful cooking is kind of multifaceted, right? I think it's being aware of what's in season. Here we are in August and in the Carolinas. What's in season this time of year, right? We have tomatoes and peppers and corn and okra, and we have all these different things that are uniquely delicious and in season. But it's a conversation when I talk about local food and talk about sustainability. I ask people, it's a very cliche question: when would you like to eat a tomato? July? August? Or January, February. And people say, 'Oh, well, of course, July or August. That's when the tomatoes are delicious and they're bright in color and they're ripe and they're juicy and sweet.' And I think those are the things that we're not being as thoughtful about nowadays. About where our food comes from and why things are in season.

So, I think that's one aspect of it. Another aspect of it is it's just taking the time to be mindful of the world around us. I think we're all moving so fast that I want people to be able to slow down and enjoy cooking. Cooking as a father of two, running many businesses, I joke with my kids it feels like a chopped competition in my kitchen. Some days when I open the fridge and I've got 30 minutes to make dinner for a couple hangry kids. But also taking the time to enjoy cooking. I think there's something to be said about slow food and taking the time to cook in your kitchen, open a bottle of wine, turn the music up. Actually connect with people around you rather than just staring and scrolling on your phone. I think it's a way to really bring people together.

And then the other, the other facet of it is, thoughtful cooking is that the way we choose to eat really creates an opportunity to vote with our forks. That there's a lot of advocacy and sustainability you can do just in taking the time to think about where your food comes from.

I can so relate to what you're saying. Not too far from where I live in Durham, North Carolina, there's an unbelievably wonderful farmers market. The state farmers market in Raleigh, which I imagine you've been at, been to one time or another. But what a pleasure it is to go there when the strawberries are just coming into season and then the blueberries and then the peaches and then the apples. Not to mention all the vegetables. And we just this weekend had guests and made a corn and tomato salad with all these wonderful things that were there. It just felt that there's something special about making it when you've gone to buy the ingredients from a farmer who grew them. And you're right, everything, every part of the experience is better doing that. How in the restaurant do you try to accomplish getting people closer to the food and more thoughtful about it?

At our flagship restaurant, The Marketplace in Asheville, the whole premise is local food sustainability. I really like to show that we can create a sustainable business that can last the test of time. And I think we have, as we're celebrating our 45th year this year in 2024. But for me it's taken the time to meet the makers. The artisans who are making cheeses or types of charcuterie. Dairy farmers, vegetable farmers, livestock farmers, fishermen. And taking the time to talk to them about what they do to be a little more thoughtful and inquisitive about how we're eating. Doesn't necessarily mean that we're all eating healthy food all the time, right? But understanding how they're taking care of it.

As you really dive into the food system, there's a lot of things that if you look at what's happening behind the scenes in some of these big, bigger commercial commodity farms - you may not like about people are being treated that are growing the livestock or the vegetables. About how they're treading on the environment in a non-sustainable way. And then also, what's going into the product that's going into your body? Are they putting hormones on or different types of spray or whatnot, you know, to cut the chemicals that could affect your body in the long run.

And I know I'm not a crazy health nut, but I want to make sure that, when I'm eating clean, I feel good. And I think a lot of it too I was very fortunate after I did undergraduate studies at West Virginia university, I went on to the culinary Institute of America for culinary degree. And I took a wine course there. It really imprinted on me about viticulture with how they grow grapes. They study this thing called a Brix level, which is the sugar level in a grape. They use this fancy electronic device called a mass spectrometer that measures the sugar content in a grape. And so, the vintners go around their farms, and test the grapes as they are approaching ripeness. They wait to pull them off the vine until the grapes reach that perfect ripeness because the grapes are higher in sugar. They're naturally sweeter. They're going to ferment into more delicious wine, but every fruit and vegetables has a Brix level. So if we're able to really be in touch with, with nature, with the time of year, when vegetables and fruits are ripe, they're naturally going to taste better. The vegetables are going to be bright in color heavy for their size because they're naturally ripe and sweet and they're just going to taste better. I don't know about you, but that doesn't necessarily make me feel like I'm a health nut. But it makes me feel like I'm in search of great flavor.

Well, it shows how much you appreciate good food and how important good food can be for the way we feel about ourselves. Obviously for the environment and things. You know, I've often thought it would be a wonderful experience to go to a restaurant and have a meal, but before the meal, be able to interact with the farmer. The farmer comes in and talks about whatever she or he has contributed to that particular meal and how the food was created and what their relationship is to the land and whatever practices they use. You get those things outside of a restaurant. But I've always thought it'd be really interesting in a restaurant to do that kind of thing. Maybe that's something you've already done.

We've definitely hosted a number of farm dinners. I actually have one coming up. There's a group out of Santa Cruz, California called Outstanding in the Field. This will be our eighth dinner we've done with them over the years. But we will do a white tablecloth dinner in the middle of a farm field for 200 people and cook over a wood fire. And you know, the hogs and the sheep are grazing the pasture beside it. And the vegetable garden is in other pasture over. And for a lot of people, they've never stepped foot on a farm. And it's a really transcending experience.

I think the answer to this is pretty obviously yes. But it seems like today's youth, like I think about students that I teach in college, are so much more interested in the story of their food than people were just a generation or two ago. But I think I, when I grew up, all we cared about was that we had food. And the, you know, the better it tasted, which basically meant how much it was processed and how much sugar and things it had in it. That was really about all we knew. But now people are asking a whole different level of questions about where their food came from. Do you see opportunities for working with children to help maximize that?

I do, yes. There's an organization that I've been on the board for a long time locally called the Appalachian Sustainable Agriculture Project. They have a subsidiary called Growing Minds Program. And it works to put healthy local food into schools and to teach children about the opportunity to healthy and eat fresh. I think it's a great thing.

I do a lot of food advocacy work as well on Capitol Hill where I go and lobby for different food policy. I've done that at Capitol Hill, you know, and internationally as well. I helped create the Chef's Manifesto for the UN's World Food Policy. And I spoke at a number of conferences around the world about it. But it starts with children, right? If we're able to teach them about eating healthy and eating local, it's going to be something that's ingrained in them forever.

And about local food, I feel like a lot of people say, 'Oh, well, shopping at the farmers market, like that's only for the 1%.' And I feel like I find a lot of great deals in the market. But a lot of farmers markets nowadays, because of different food policy and food advocacy, they have things even with SNAP benefits that they'll do two for one. So, you can really get some great deals at the market as well.

You mentioned you've done some advocacy activity in Washington arguing for certain policies, what kind of policies have you been involved with?

Given that we're in a presidential election year, I always like to tell people I don't really like politics very much, but I really like policy. Because policy is where you can take action and make change. I've done a lot of advocacy work advocating for things like the Magnuson Stevens Act, which provides federal fishery management and sustainability ratings for different species of seafood. I, also worked on the Childhood Nutrition Reauthorization Act, which was to add more funds to school lunches for children. Farm bill. Gosh, I've done so many different things. It's good to get out there. Our politicians get bombarded with different bills and lobbying groups all the time. But I think when they see somebody like myself, I’m a chef, I'm an employer, business owner, real estate owner, it's different than maybe your standard blue suit lobbyists. A lot of times take the time to listen. And many of them come in and eat at our restaurants. So, it's an opportunity to really try to direct change and hopefully when they go to vote for these various bills, they think about the opportunity that they've had to meet with constituents like myself. And hopefully they remember to do the right thing when they place their vote.

You also show how many ways there are to interact with the food system. And ways to try to make improvements, and the scope of your activity is really pretty impressive. So, let's loop back to your book. In your book, you talk about, again in the title, you talk about the New South. What is the New South?

I think a lot of people think of Southern food as shrimp and grits and gumbo and very heavy, rich country cooking. There's a lot of African American influence from the days of slavery. And recipes, ingredients that were brought over during slavery from West Africa, and traditions that arose in Southern cooking from those times. Like everywhere else in the world, the South is evolving and it's one of the most popular places for people to move to within our country, the United States. And we're starting to see this evolution of Southern food, right? It's not just this kind of typical stick to your ribs, Southern cooking anymore. We're starting to see other cultures come in. There's Indian culture, African American culture, Asian cultures that are coming in and they're taking these traditions of Southern food and local food, but then adding their flavors to it. And to me, it's a really exciting time because I’m biased, I love Southern food. I love shrimp and grits. I love these different dishes that are so wonderful. But I love when somebody comes in and they take a recipe, and they add their own touch to it and they tweak it. Because to me, that's, that's adding to our heritage as Southerners. And so, for me, recipes rooted in the New South is this evolution that we're, we're taking Southern food on.

If you wouldn't mind, give us some examples of some of the recipes that are in your book?

I have a number of dishes that I think are really exciting. One of my favorites: I have a red wine braised beef short rib. Serving that with a chili cumin sauce and then a blue cheese and green apple coleslaw. So, it's kind of taking this idea of, you know, of beef and coleslaw, but kind of adding in some other flavors from other cultures. You know, like within that there's a lot of kind of Hispanic flavors as well.

I loved looking through the recipes in your book. And I don't think there was one that I looked at where I wasn't surprised by some ingredient that I didn't expect. Or putting things together in unique ways. The book strikes me as being highly creative. I can just imagine how much work was involved in putting that book together and how long it took. It must sort of be the culmination of a lifetime of work, so congratulations for doing that.

Well, thank you. I think as I mentioned before about the other work I do outside the restaurant. I didn't just want to write a Marketplace restaurant cookbook. I wanted to write a cookbook that talks about, you know, the power of food and the philosophy behind it. But then also have some delicious and creative recipes in there that can be inspiring to folks as well.

BIO

William Stark Dissen is a renowned chef, author, culinary diplomat, restaurateur, and early pioneer of the farm-to-table movement in Asheville, North Carolina, and surrounding regions. His titles also include Seafood Watch Ambassador to The Monterey Bay Aquarium in California, and Official Ambassador for Le Creuset and Mountain Valley Spring Water. Named Fortune Magazine’s “Green Chef of the Year” two years in a row, William’s endeavors in sustainable food and dining, coupled with his passion for foraging and fly-fishing, often take him from the kitchen, into the mountain streams and peaks of the Southeastern, United States, Appalachian region, and beyond. William’s efforts to uplift the principles of food sustainability in his restaurant and network of vendors and suppliers, has not gone unnoticed. It caught the eye of Celebrity Chef Gordon Ramsay, who featured Asheville on NatGeo TV’s, “Gordon Ramsay: Uncharted, Smoky Mountains.” The hour-long episode featured William touring Ramsay through the forest and rivers of Western North Carolina and concluded with the two chefs competing in a peer-reviewed cook-off. William beat Ramsay for the first and only time in the show’s three seasons. Through this experience, Gordon Ramsay named William, “The Most Sustainable Chef on the Planet!”

A career in the culinary arts led Dissen to become an advocate for food policy on Capitol Hill starting in 2010, where he’s lobbied to Congress about the importance of passing legislation, such as The Farm Bill, The Childhood Nutrition Reauthorization Act, and The Magnuson-Stevens Fishery Conservation and Management Act. The Barack Obama administration lauded William as a “White House Champion of Change for Sustainable Seafood” for his work to create healthier oceans. He also serves in the American Chefs Corps in the U.S. State Department, which sees him traveling around the world to promote American food culture and sustainability practices.

Stories from the past help us understand who we are and who we can be. In today's podcast, we will explore a gripping new book titled "Food Power Politics: The Food Story of the Mississippi Civil Rights Movement," written by African American Studies Assistant Professor Bobby J. Smith II at the University of Illinois at Urbana-Champaign. The book tells how food was used as a political weapon against African Americans and describes how black people fought against oppressive regimes by creating their own food systems, Bobby sets the stage for understanding how black youth today in Mississippi and beyond are building food justice movements and grappling with inequalities that attempt to contort their lives.

Interview Summary

So, Bobby, what inspired you to write "Food Power Politics?"

So many different ways to answer the question. I have a family background in agriculture. I did food justice activism while I was in graduate school. I also worked on food policy councils. So, I was inspired to write it because I was already interested in understanding the ways in which food was produced, consumed, and distributed. But what inspired me to write "Food Power Politics" was actually a class I took while I was in graduate school at Cornell University in the Department of Developmental Sociology. I'm taking a course around community development and organizing and we read a book by sociologist Charles Payne entitled "I've Got the Light of Freedom." It's about the Civil Rights Movement in Mississippi, particularly the area called Greenwood, Mississippi in the Yazoo Mississippi Delta Region of the state of Mississippi, which is the northwest quadrant of the state. And in the book, Payne talks about the organizing tradition of the Civil Rights Movement. And during that class, I'd already been interested in understanding, again, issues of food justice and food security. So, as I was reading that book, I learned about the ways in which food became a weapon used against the Civil Rights Movement and civil rights activists responded by organizing their own food programs. And essentially, I wrote "Food Power Politics" because I wanted to raise awareness about how food can be used in different ways. But I also wanted people to rethink the idea of food. Many times, people think about food as something that's on your plate or something you get at the grocery store. But what inspired me to write "Food Power Politics" was to show a different story about food and how it impacts the lives of African American people.

Thank you for that. And I have got to tell you, I'm intrigued by the phrasing of "Food Power Politics." Could you please unpack its meaning and explain how you map it across the landscape of Black life?

"Food Power Politics" is the title of my book, but it's also the theoretical framework that I created to begin to understand, or for scholars and other people to interpret, how food can be used as a weapon. The book started as ideas for my dissertation. When I first learned about the ways in which food had been used as a weapon against African American communities, I started looking to the literature to find out how have people talked about food as a weapon. I remember talking to a number of my colleagues about the book itself and they were telling me stories about how the idea of food as a weapon is just what we call wartime tactics. So, food has been weaponized for many, many years, and centuries. So, I went to the literature, and I found out that scholars, typically legal scholars, historians, and political scientists, when they talk about how food when used as a weapon, they use the term food power. I had never heard of food power before or this framework of food power. So I, of course, as a diligent graduate student, delved into the literature and learned more about food power. And it's a concept that is usually understood in the context of international conflict whereby one nation withholds food from another nation in times of conflict as a way to mitigate the impact of the conflict, or that the nation that wills the power against another nation can win the conflict. That's what they call food power. So, I used the concept of food power and transposed it into the context of the Civil Rights Movement. And while I was studying the Civil Rights Movement, food power allowed me to think about how food had been used as a weapon against African communities, but it didn't allow me to pick up on how African American communities fought back. And that was a key part for me because many times when we think about times of oppression or social struggle, we tend to think about how oppressors oppressed people and not have those who are oppressed fight back. So, when I observed what African American communities were doing in Mississippi in response to food being weaponized against them, I theorized ideally emancipatory food power, which allows or creates this way for us to understand how African American communities use food as a way to emancipate themselves from those kinds of conditions and circumstances. So, the conflict between food power and emancipatory food power equals or is a sense is where I theorize as "Food Power Politics" which captures those struggles. I didn't want to show just one side of the struggle by which food is used against African American communities. I wanted to show both sides. And that's what the concept of "Food Power Politics" seeks to do. It gives us language to understand these instances, whether it's during times of enslavement in the African American experience or in times of Jim Crow or civil rights or even today. It gives us language to understand the ways in which food is used in times of social struggle.

This is really rich. I'm so intrigued by the idea of taking from geopolitical conflict, this notion of food power and this idea of food power against, but you also talk about food power for, and that was an important move because it shows how people can take possession of their lives and use food, that can be so complicated, for their good. And so, I hope we'll talk a bit more about that. But I really want you to take us back in time. So, what is the food story of the Mississippi Civil Rights Movement and why do you think it's important?

So, thinking back when I talked about Charles Payne's piece, "I've Got the Light of Freedom." He talks about how food was used as a weapon against African American communities. So, although Charles Payne's book is not about food, it's not about agriculture. It's a strictly civil rights, Black Freedom Struggle type of book. But in chapter five of the book, he recounts this moment activists now called the Greenwood Food Blockade. And the food story of the Mississippi Civil Rights Movement, or the story that I want to tell, begins with this Greenwood Food Blockade. In short, it is this moment where the White political structure there in the Yazoo Mississippi Delta Region through the city of Greenwood, Mississippi, in Ford County, is where they begin to use food as a form of voter suppression. So, there's this federal surplus commodities food program. Government cheese, or government peanut butter, meats, and things like that. At the time in the Delta Region of Mississippi, that program was a big program for rural African American communities. In 1962, the Florida County Board of Supervisors decides to dismantle that program. And that was the only way that our poor world Black communities were able to even get food. Many of them were sharecroppers or farm workers or day laborers, and many of them didn't have any money to buy foods. So, all the food they got and the ways in which they fed themselves was mostly through this federal surplus commodities program, which is what they call the Surplus Food Program. So, in 1962, the Florida County Board of Supervisors in November of 1962 decide to dismantle the program as a form of voter suppression. So, what ends up happening is that now activists who are in Mississippi begin to make connections between food and the struggles of sharecroppers. And so essentially the food story of the Mississippi Civil Rights Movement begins with this event called the Greenwood Food Blockade. And in response to the blockade, activists organized what they call the Food for Freedom program. So, that's one of the first times we see these tensions between food power against and food power for. The blockade itself is one where food power is used against these communities. And then the Food for Freedom program is designed to respond to that lack of food that is engineered by the Greenwood Food Blockade. That's my entry point and that's how I even found out about this food story of the Mississippi Civil Rights Movement. And in 2017 when I was a graduate student, I went to Mississippi to learn more about the Greenwood Food Blockade. I wanted to locate activists who knew about it. I went to the places where the Food for Freedom program operated, and I learned so much about the Greenwood Food Blockade. But while I was in Mississippi, I also learned about another part of this story. So, during the Greenwood Food Blockade, while activists are responding to this use of food as a form of voter suppression, there's also this food stamps campaign that is engineered by White grocery store owners in the Delta and across Mississippi. Now, I call it a food stamps campaign because in 1962, our nation did not have a Federal Food Stamp program. It was a pilot program at the time. White grocery store owners in Mississippi wanted food stamps, but not food stamps to feed people; they wanted food stamps to make profit. They also wanted to get rid of the federal surplus commodities food program because they believed that that program would cut into their profit. So, once I learned more about this Federal Food Stamps campaign in Mississippi, I soon learned that another way in which food had been used as a weapon against African American communities was also through the Federal Food Stamp Program. The Greenwood Food Blockade is food as a political weapon. And then this Federal Food Stamp campaign by White grocery store owners is food used as an economic weapon, and how activists and how sharecroppers in those communities responded to that campaign was how they developed food cooperatives. Throughout each chapter of the book, I provide a case study of how food is used as a weapon against African American communities and how they respond. But they respond in different ways because when it's a political situation, they respond by attaching food to civil rights activism and freedom. Whereas the food stamps, they realize whether we have surplus commodities or whether we have food stamps, we can't control when, where, and how we access food. In response, they start developing these food and farm cooperatives in Mississippi, and that's the way we see how food can be used as a weapon against, but also how being those communities counter weaponized. And then I follow that story and situate it through today and show how particularly Black youth in the Delta today continue the food story of the Mississippi Civil Rights Movement, recognizing that things are different today and that a lot of the power structure has morphed to fit today's context. But communities are still struggling to counter weaponize the ways in which food has been used against them.

You are already leading into the next line of questioning and that's this idea why your text mostly is about historical events. You do, of course, bring it to today. And I'd like to hear you talk about this. How do you envision your book contributing to the contemporary work of food activists and their communities?

Honestly, when writing books or articles, you never know who might have access to it or who might get it. And my hope for at least communities or those who are actually on the ground doing the work around food justice or food sovereignty or any type of food movement, I want them to use the book as a part of their arsenal of stories to develop blueprints to think about the future. The reason why I wanted to end the book with thinking about Black youth, because the Black youth that I studied in the book, they were directly continuing this food story of the Mississippi Civil Rights Movement, which also showed me that there's some unanswered questions left from the past that we still need to address if we're going to create this socially just food futures. I'm hoping that my book can be used by activists to show them that they're not by themselves. In fact, they're part of a legacy, a genealogy if you will, a lineage of people who have always put food at the center of social struggle to think about how can we ensure that everybody is food secure? I couldn't leave the book in the civil rights era. I wanted to think about how people today, so the rural Black youth that I write about in chapter four in the book, they continue this story, but they're thinking about how can we, one, reclaim the past but also make it fit today? The local foodscape of the Delta is different now, back then, the Delta's Foodscape was shaped by mostly commissary stores and a few grocery stores as well as these plantation stores. And they all worked together to create this type of food outlet or food environment for to be poor world Black communities. But today we have a prevalence of corner stores, a prevalence of liquor stores, dollar stores, and those type of stores that carry cheap and highly processed foods or even no foods. And that's the foodscape by which activists are navigating today in the Delta. And I wanted to create a type of book that could help them think about how we can use history as a way to shape our strategies? Because while I tell the food story of the Mississippi Civil Rights Movement, there's a food story of the Alabama Civil Rights Movement, a food story of the North Carolina Civil Rights Movement. And I want to give people permission to begin to excavate those stories and think more about how it relates to the work they're doing today.

That's really helpful. I mean, you clearly have an eye toward the public to say, "What can folks who are on the ground doing the work of trying to fight for food justice pull from the past to use as strategy, as motivation, as even hope?" And I really appreciate that. Now I want to shift gears and talk a little bit about policy because I'm at a policy center and I'm interested to understand what we can learn about current conversations about federal, agricultural or food policies, given what you say?

I appreciate this question, Norbert. So, next year marks 60 years since Lyndon B. Johnson signed the Federal Food Stamp bill, which created food stamps. We call SNAP today the Supplemental Nutritional Assistance Program. What does it mean to think about food stamps 60 years later? My book provides an untold history, if you will, about the food stamp program. When many people think about federal food policies, they think about these policies as a way to ensure that people get something to eat. People need these programs to get access to groceries, get access to foods from a number of places. But historically, these food policies and ag policies were not necessarily designed to impact the public at large. And I think it's important for us to understand it as we think about how we're going to revise these programs to ensure that they're meeting the needs of the actual recipients. What we do know about food stamps is that in the past, it was designed while Lyndon B. Johnson and others argued in the 1960s that it was a part of this larger war on poverty and that it would help people get out of poverty. But food policies are not necessarily designed to get people out of poverty. It doesn't necessarily give them more actual money for them to take care of other things in their lives. Now, while it gives them some type of supplemental food assistance that then could possibly increase their income, it doesn't give them direct aid. And what I want my book to do is for us to begin to complicate how we think about ag and food policies and recognizing that while on the surface or when we read the legislation, it's designed to do X, Y, and Z, what actually happens and what we do know in the 1960s after the Federal Food Stamp program is passed, and it comes in Mississippi, people become more food insecure in Mississippi. And that's interesting to understand because people think when food stamps come to Mississippi, oh, now everybody can eat. And in fact, civil rights activists were saying, "Actually, no, we can't even eat now because you have these requirements." And that's also what we're seeing today. Activists have been organizing to shift the requirements of what it means to get SNAP or what it means to get food aid. And year after year or every five years under the Farm Bill, it gets harder and harder for people to get something to eat. But somebody's still making money from these policies and I'm hoping that my book provides at least an entry point or a window into complicating those conversations. I mean, if the goal is to feed people through food policy, then I'm hoping that we can learn this history, learn from it and as a way to revise what's going on presently to impact the future.

As you know, USDA just released its most recent estimates of food insecurity in the United States and there's been an increase.

Yeah, I saw that. Yeah.

Yeah, and the fact that we're now in the conversation around the Farm Bill and what's going to happen there. I think there's some important policy conversations that need to take place. And one thing, of course, given the origins of your book and where you're located, in addition to thinking about the policy, there are racial and societal concerns that also crop up. Thank you for exploring these issues and trying to recognize the complexity of the lives that we live. So, I appreciate your project there.

Thank you for framing it the way that you did. I'm glad you borrowed the food insecurity increasing because it's important to recognize that nationally, it's gone up. So, what does that mean for those demographics that were already disproportionately impacted by food insecurity? Thank you for bringing up that particular point.

I understand that your book is the inaugural publication of the newly launched Black Food Justice series at the University of North Carolina Press. That's wonderful. Congratulations.

Thank you. I appreciate that.

My last question for you is how do you see your book reshaping our understanding of food justice?

I've been thinking a lot about food justice, at least for the past 10 years. And in many conversations about food justice, there's been an explicit focus on thinking about race, but mostly thinking about race in the context of what we called the local food movement. So many of us, even myself, have argued before about how the local food movement is overwhelmingly White and overwhelmingly affluent and that poor people or people of color or Black people can't even get access to the movement. And while that was important, some maybe five years ago thinking about food justice, what my book shows is that the story of food justice or the development of the movement has deep roots in the arc of the Black Freedom Struggle in the United States. And I think that's important because when we begin to think about food justice, we tend to automatically connect it to the Environmental Justice Movement of the 1970s and 1980s. And what my book shows is that in fact, Black folks have been doing food justice since they were enslaved. They just didn't have the language to call it food justice because they were just attempting to survive. They were trying to make new worlds in a strange world they were brought to when they were enslaved because there wasn’t any knowledge. So, what my book shows or extends or what it does or what it begins to reshape, if you think about this idea of food justice, is that it shows that there's more to food justice than just an opposition to local foods or just opposition to the absence of Black people at farmer's markets and CSAs. In fact, food justice has a deep history in how Black people reimagine their worlds and how they put food at the center. And I believe that's what my book does. It reshapes our understandings of food justice, and it provides concrete examples of how food justice morphs with the times. How it looked during times of slavery versus Jim Crow versus civil rights versus current that we find ourselves in. In the sense, what I'm attempting to do is I'm showing how it connects food justice connect to civil rights, but also, I'm showing more largely how the food justice movement, in many ways, African Americans provide the blueprint for understanding how we can achieve food justice in our nation and around the world today.

Bio

Dr. Bobby J. Smith II is an interdisciplinary scholar of the African American agricultural and food experience. Trained as a sociologist, with a background in agricultural economics, Dr. Smith is an Assistant Professor in the Department of African American Studies at the University of Illinois at Urbana-Champaign, with affiliations in the Department of Food Science & Human Nutrition and the Center for Social & Behavioral Science. He is the author of Food Power Politics: The Food Story of the Mississippi Civil Rights Movement (University of North Carolina (UNC) Press, 2023), the inaugural book of the newly launched Black Food Justice Series at the University of North Carolina (UNC) Press.  Dr. Smith earned a B.S. degree (summa cum laude) in Agriculture, with a focus on Agricultural Economics, from Prairie View A&M University in 2011. He earned a M.S. degree in Agricultural and Applied Economics in 2013 and a Ph.D. in Development Sociology in 2018 from Cornell University. Most recently, Dr. Smith has been awarded fellowships from the American Council of Learned Societies (ACLS) and the National Endowment for the Humanities (NEH), among others.

In August of 2023, the Food and Drug Administration issued something known as a direct final rule, disregarded trans fats in the food supply. Consumers won't notice changes as the rule just finalizes FDA's 2015 ruling that partially hydrogenated oils - trans fats - no longer had "GRAS status." GRAS stands for generally regarded as safe. We cover this issue today because this trans fat ban was the product of lots of work by a key group of scientists, the advocacy community, and others. The anatomy of this process can teach us a lot about harnessing scientific discovery for social and policy change. At the center of all this is today's guest, Dr. Walter Willett. Willett is one of the world's leading nutrition researchers. He is professor of epidemiology and nutrition at the Harvard T.H. Chan School of Public Health, and for many years served as chair of its Department of Nutrition. He's published extensively, been elected to the National Academy of Medicine, and it turns out, is the world's most cited nutrition researcher.

Interview Summary

There are so many things I could talk to you about because you do work in such an array of really important areas and have just made contribution after contribution for years. But let's talk about the trans fat because you were there at the very beginning, and it ended up with a profound public policy ruling that has major implications for the health of the country. I'd like to talk about how this all occurred. So, tell us, if you would, what are trans fats, how present were they in the food supply over the years, and what early discoveries did you and others make that led you to be concerned?

Yes, this is a story from which I've learned a lot, and hopefully others might as well. Trans fats are produced by the process called partial hydrogenation. This takes liquid vegetable oils, like soybean oils, corn oil, canola oil, and subjects them to a process with high heat and bubbling hydrogen through the oil. What this is doing is taking essential molecules, essential fatty acids like the omega-6 and omega-3 fatty acids and twisting their shapes just subtly, and this turns them into a solid fat instead of a liquid fat. And, of course, the food industry likes this because our culture, the Northern European eating culture, emphasizes solid fats like butter and lard. Industry really didn't know what to do with all the liquid oil that they were able to produce by another process that was discovered back in the late 1800s. The partial hydrogenation process was actually developed in about 1908, and someone actually got a Nobel Prize for that. It wasn't used widely in the food industry till the 1930s and 1940s when it was upscaled because it was cheaper, for multiple reasons, to partially hydrogenate oils and turn them into solid fats like Cricso and margarines. I got worried about this, actually, back in the 1970s, when other scientists were discovering that these essential fatty acids are important for many biological processes, clotting, arrhythmias, inflammation, and counteracting inflammation. I realized while studying food science at that time that there was nobody really keeping an eye on this. That there were these synthetic fatty acids in massive amounts in our food supplies. Margarines, vegetable shortenings were up to 30% and 40% made of trans fatty acids. And that may me concerned that this could have a big downside. So, back in 1980, with the help of some people at the Department of Agriculture developing a database for trans fats in foods, we began collecting data on trans fat intake in our large cohort studies. And about 20 years later, we saw that trans fat intake was related to risk of heart disease. We published that in 1993. That got us started on the pathway to getting them out of our food supply.

Let's talk about how present they were in the food supply. You mentioned some things like margarine and Crisco, but these fats were in a lot of different products, weren't they?

Yes, they were almost everywhere. You could hardly pick up a product that had a nutrition facts label that didn't say partially hydrogenated fat on it. It was really in virtually everything that was industrially made in our food system.

Just because they could produce them at low cost? Or did they have other properties that were desirable from the industry's point of view?

These trans fats had multiple characteristics. One, they could be solid. And again, because they mimicked butter and lard, it fit into lots of foods. Second, they had very long shelf life. Third, you could heat them up and use them for deep frying, and they could sit there in fryolators for days and not be changed. So, this was all good for the food system. It wanted really long shelf life and started with cheap ingredients.

So, after those initial findings that raised red flags, what kind of research did you do subsequently and at what level of proof did you feel policy change might be warranted?

Within our own group, we continued to follow our participants. These are close to 100,000 women in the Nurses' Health Study, and also another 50,000 in the health professionals follow up study. We confirmed our initial findings and then found that trans fats were related to risk of many other conditions, from diabetes to infertility. And simultaneous with our work in the 1990s, some of our colleagues in the Netherlands were doing what we called controlled feeding studies. These studies take a few dozen people and feed them high trans fat or low trans fat for a few weeks and watch what happens to risk factors like cholesterol levels and triglyceride levels. And they found that trans fats had uniquely adverse consequences. They raised the bad cholesterol, LDL cholesterol, and reduced the good cholesterol, HDL cholesterol. So, they had unique adverse biological effects. It was really that combination of that short-term kind of study and the long-term epidemiologic studies we were doing that made a compelling case that trans fats were the cause of cardiovascular disease.

So, a line of considerable work took place over a number of years, and then got to that point where you felt something needed to be done. And the fact that you did that science and that you were worried about these trans fats in the first place is impressive because you were really onto something important. But what happened after you did the series of studies? What steps occurred and who were the key actors that finally led to policy change occurring?

Well, as we expected, there was pushback from the industry about this because they were so invested in trans fat. And I was actually disappointed that a lot of our colleagues in the American Heart Association and others pushed back as well. They didn't want to distract from saturated fat. But, when studies were reproduced, it was really undeniable that there was a problem. But, if the studies had just been put on a shelf and sitting there, probably nothing would've happened. And it was really important that we partnered with advocacy groups, particularly Mike Jacobson, Margo Wootan at the Center for Science in the Public Interest, because they had a readership and audience that we didn't have. And they also were more familiar with the workings of the Food and Drug Administration and government in general. But I also was told somewhere around that time that women, who are the main food purchases, pay most attention to a lot of the women's journals, Family Circle, those kinds of journals. And actually, for good reasons. Their journalists are very good. So, I've talked to those journalists every opportunity. And it turned out it was really important to have some public awareness about this problem. If it was just good science and things worked as they should have, the FDA would've looked at the evidence and just ruled out trans fat from our food supply early on, but they didn't. It really took major concerted effort by the combination of the scientific community and the advocacy group.

Did you bump into conflict of interest problems with other scientists who were receiving funding from the industry and you know them talking to the press or speaking at conferences or things like that?

Well, there's plenty of conflicts of interest within the nutrition community, but actually, I don't think that was so much of an problem here. In some ways, there was a conflict of sort of personal commitment to entirely focusing on saturated fat and not wanting to see any distraction. I don't think a conflict of interest in the economic monetary sense.

Walter, I remember back when this discussion was occurring and industry was fighting back. They made claims that food prices would go up, that the quality of foods would go down, that it would be a real hit to their business because consumers wouldn't like products without the trans fats. What became of all those arguments?

It's interesting and it's important to keep in mind that the industry is not monolithic. And I have to credit Unilever, actually, with paying attention to the scientific evidence, which was really rejected here. Interestingly, at that time, all the major margarine manufacturers were owned by the tobacco industry. And you can imagine that those CEOs were not getting out of their bed in the morning and saying, well, what can I do to make Americans healthier? No, they were not interested in health. But Unilever was a food company and it was invested in staying as a food company for the continuing future. And they did realize that this was a problem, and they invested a lot of money to re-engineer their products, re-engineer their production of margarine and shortening. And they did take trans fat out of their products. They obviously did a lot of taste testing to make sure they were acceptable. And once they did that, the industry could no longer say that it's impossible to do it. It's sort of like the automobile industry when Detroit said, you just can't build low pollution cars, but then the Japanese did it and then they could no longer deny it.

Boy, it's such an interesting story that occurred. With Unilever getting involved as they did. That must have been a very positive push forward. They're second biggest food company in the world.

That was really helpful. And again, I think it was because they had a lot of scientists, both nutritionists and food chemists. I was told they had about 800 such employees at that time. They could see, if you looked at the evidence honestly, this was a serious issue. One of their chief scientists later told me that it was actually one of our editorials in the American Journal of Public Health where we estimated that there would be about 80,000 premature deaths per year due to trans fat. And once they saw that, they said, we can't have Willett going around saying there's going to be 80,000 premature deaths, and they realized they had to do something. It's interesting, you write an editorial, you don't know who's going to read it, but sometimes it hits one person who can really make a difference.

It is nice to know that people read things like that once in a while. Let's go to where you were at that point. You produced a lot of science. You were communicating this to professional audiences, but also to the general public with interviews and magazines and things like that. And the advocacy community, especially the Center for Science in the Public Interest, got activated. What happened then?

Well, a couple things happened. One is that they brought up and proposed labeling trans fat on the nutrition facts label and submitted that to the FDA. The FDA sat on it. There was, of course, lots of backdoor action by the American food industry that did not want to change what they were doing. And despite some prodding by CSPI over the years, that sat there for about 10 years almost. Ironically, there was a faculty member at Harvard Chan School of Public Health at that time who had seen a display we had done on trans fat. We built a big tower out of blocks of trans fat and had a little poster there talking about it. He went to Washington and became a senior person at the Office for Management and Budget. And Mike Jacobson went to go visit him with a petition to label trans fat, and our faculty person said, I know about trans fat because Willnett had that display in our cafeteria. He wrote a letter to the FDA that was quite unprecedented, basically saying that either put trans fat on the food label or tell us why not. Which is a quite strong letter. And then the wheels started turning, and there was delay and delay for a pushback on the food industry. But by 2008, trans fat actually did get on the food label. And that had a very major impact, because once it had to be on the label, the food industry took it out. They sort of knew it was coming because they didn't want to admit it publicly. But I think they understood for quite a while that they were going to have to get it out, but that was really the turning point. All of a sudden, almost all the food products had zero on the trans fat line there.

Let's talk about the public health impact of this. You mentioned 80,000 or some deaths occurring each year attributable to consumption of trans fat. Can we conclude from that that we're saving that many lives now with trans fat out of the food supply? And does that mean 80,000 lives year after year after year?

It's hard to know exactly and of course, so many things are going on at the same time. And the trans fat didn't go down abruptly because Unilever was, even in the American market, a pretty major producer, starting by the mid 1990s, trans fat intake actually did start to go down. And other things are going on, obviously obesity epidemic counterbalancing a lot of positive things that were happening. But, there were some economists looking at communities that adopted trans fat bans early on versus those that did not, and they could show there was a divergence in heart attacks and hospitalizations for heart disease. So it's hard to pin an exact number on it, again, because all these things happen at the same time. But it's quite clear that we would be having quite a bit more heart disease if trans fat had not been eliminated. I would also look back to another important step in the process because even though we got trans fat on the food label, and the products that had it quite quickly became, almost all of them, zero trans fat, but that didn't deal with a restaurant industry, which was also a very big source of trans fat. And there it took community activists to make this happen. There was a small community in Northern California that was really the first community that banned trans fat in restaurants, and a few other places did. But then Mayor Bloomberg of New York, there's another backstory why he got interested in this. But it's one of these things, you put out information and you don't know who's going to read it, and someone had read some of our work and to convince his health department and Bloomberg himself that trans fats had to go, and New York banned trans fats. And then some other communities, Massachusetts and elsewhere in the food industry, the restaurant industry realized they couldn't have a patchwork distribution system. And so that was a tipping point that trans fat was eliminated in the food service industry long before the FDA finally made the ruling. In fact, by the time the FDA made the ruling about trans fat and pressure hydrogenated fat, it was almost gone.

To go back and look at the history of this, it's a relatively small number of key people taking the right actions at the right time that ultimately led to change. And thank goodness for those people like you and Mike Jacobson, Margo Wootan, and Mayor Bloomberg, and a few other people in political circles that took the bull by the horns and really got something done. Very impressive. As you look back on this, what lessons did you learn that you think might be helpful for future policy changes?

I think there are a number of lessons. I'd like to think, first of all, that solid good science is really important. Without that, we couldn't have a hard time making changes that we need to do. But that's usually not going to be enough. It's really important to work with advocacy groups like CSPI. It's important, sometimes, to work with journalists and provide good information, education. But it's hard to know exactly which path is going to be successful. One thing is quite clear, in this country, in many areas, change does not happen from the top. It's not enough just to have good science. And oftentimes, changes happen from the bottom up at the local level, the state level, and the national government may be the last place where action occurs.

So what changes in the food supply do you feel would be most pressing right now?

We certainly have a lot of problems in our food supply. If you look around, most people are consuming diets and beverages that are quite unhealthy. And there are so many issues, I think, still and we've worked on this issue is a sugar sweetened beverage issue, and we've had some real progress in that area, but still, there's a huge way to go to reduce sugar sweetened beverages. But that's part of a bigger problem in terms of what we're consuming. And I would call that carbohydrate quality, that about half of our calories come from carbohydrates. In about 80% of that half, in other words, about 40%, of all the calories we consume are refined starch, sugar, and potatoes which have adverse metabolic effects, lead to weight gain, lead to diabetes, lead to cardiovascular disease. So that's a huge area that we need to work on.

You've talked, so far, with the trans fat and, you know, and with other things in the food supply like salt, these are things that you'd be taking out of the food. That all makes good sense. What about putting things in? Talk about things that might support the microbiome, more fiber, or things that might support brain health and things like that, so what are your feeling about those things?

You're right, our problems are both what's there in quantities that are unhealthy and also what's missing. Inadequate fiber intake is actually part of the carbohydrate problem. Clearly, we should be consuming many more whole grains compared to the amount of refined grains that we consume. And, of course, we get some fiber from fruits and vegetables. So I think, in addition to this huge amount of unhealthy carbohydrates and inadequate amount of whole grains, we do need to be consuming more fruits and vegetables. And then on the sort of protein source side, we're clearly consuming too much red meat and replacing that with plant protein sources like nuts, legumes, and soy products would be really important for direct human health. But also, that's an area where the environmental and climate change issues are extremely pressing and shifting from a more animal-centric diet to more plant-centric diet would have enormous benefits for climate change as well as direct effects for human health.

Bio

Walter C. Willett, M.D., Dr. P.H., is Professor of Epidemiology and Nutrition at Harvard T.H. Chan School of Public Health. Dr. Willett studied food science at Michigan State University, and graduated from the University of Michigan Medical School before obtaining a Masters and Doctorate in Public Health from Harvard T.H. Chan School of Public Health. Dr. Willett has focused much of his work over the last 40 years on the development and evaluation of methods, using both questionnaire and biochemical approaches, to study the effects of diet on the occurrence of major diseases. He has applied these methods starting in 1980 in the Nurses' Health Studies I and II and the Health Professionals Follow-up Study. Together, these cohorts that include nearly 300,000 men and women with repeated dietary assessments, are providing the most detailed information on the long-term health consequences of food choices. Dr. Willett has published over 2,000 original research papers and reviews, primarily on lifestyle risk factors for heart disease, cancer, and other conditions and has written the textbook, Nutritional Epidemiology, published by Oxford University Press, now in its third edition. He also has written four books for the general public. Dr. Willett is the most cited nutritionist internationally. He is a member of the National Academy of Medicine of the National Academy of Sciences and the recipient of many national and international awards for his research.

White Oak Pastures is a sixth generation, 156-year-old family farm in Bluffton, Georgia. It's also the home of Rancher Will Harris who runs an expansive, zero waste production system with the animals he pasture raises and butchers on the farm. White Oak Pastures produces grass fed beef, lamb, goat, and Heritage pork, and pastured turkeys, chicken, duck, geese, and more. Will is a vocal and passionate champion of radically traditional farming as the path to regenerative land management, humane animal husbandry, and revitalizing rural communities. This is the second time we've spoken with Will Harris. The first time came right on the heels of a really interesting national meeting held in Tennessee on regenerative farming, where I became very impressed with Will and the work he's doing. He was kind enough to join us for a podcast at that time. Our discussion today happens to coincide with the release of a book that Will has written entitled, "A Bold Return to Giving a Damn: One Farm, Six Generations, and the Future of Food.”

Interview Summary

I really would love to dive into the meaning behind the title of your book, and what you wrote about. But let me ask you a few lead-in questions. Many years ago, you made a profound change in the way you approached ranching and farming. What convinced you back then that this kind of change was necessary? And tell us what you did if you would.

My dad ran the farm before me. He was born in 1920, took over the farm post World War II, 1945. He was the generation that really industrialized, commoditized, and centralized the farm. It went from being the really typical 19th century farm under my great-grandfather and grandfather, to being a monocultural cattle operation. My dad was very, very good at it, a great cattleman. He ran the farm profitably. And all I ever wanted to do was come back and run the farm as a monocultural industrial cattle operation. I just loved it. I went to University of Georgia in 1972 and majored in animal science with the intention of coming back, and I did. And I loved it. You know, we weren't wealthy people, but we made money every year. We paid taxes every single year. And I was happy for a long time. But, in the mid-nineties, the excesses of that industrial monocultural model, became displeasing to me. When it started, it happened fairly quickly, and I decided to change. I did not have a goal to move towards, I just knew what I wanted to move away from. I started moving away from it almost 30 years ago, and I've been moving away from it ever since.

I'd love to follow up on one thing that you mentioned, and it's the generational nature of kind of farming overall, and your farm. Several years ago, I did a tour of farms in Eastern North Carolina, and I was really impressed with how important the family aspect of that was. Could you just tell us a little bit about that? What does that mean to you and six generations? That's really impressive.

The family aspect of it is a blessing and a curse, but it's been a blessing for us. This is just the way it is. My dad was an only child, and I am an only child. So, the passing down of the asset, the farm, farmland was very easy for us. I'm reminded that the old European way of all the assets going to the eldest son was certainly not fair, but I think that went a long way towards ensuring that the asset was passed down and kept intact, as opposed to dividing it up equally among the two, three, four, six, seven siblings. I have three daughters, two of which have come back to the farm. And I will leave the farm to those two daughters. So, our farm is unusual. And it's five, maybe six generations old, but it too will cease to be at some point. That's the way it is. There are other people that want to start farming, that need the opportunity. So this, it's just a good healthy, natural business system.

You referred to the farm as an asset, but I have a feeling it's more than that. I mean you could be passing down to subsequent generations a service station, or a convenience store, or a dry cleaner or something like that. But I have a feeling that the fact that you're passing along something that is tied to the land, it just has so much more meaning. Tell me if I'm wrong.

No, you're exactly right. But I put a finer point on it. There are not many non-depreciating assets. Land is a non-depreciating asset. I guess gyms are a non-depreciating asset, probably art. There just aren't many assets that don't have a finite life for them. But land is one of them. It's perpetual. And I would argue that the herds also are perpetual. Certainly, the individual animal in the herd has an expected lifespan, but the herd itself is perpetual. My cattle herd literally goes back genetically to the cattle my great-grandfather brought here 150 years ago. So, when you take that perspective, it turns the asset that you inherit or build up or however that goes, it turns it into something very, very special. And I think it should be treated that way.

So, let's get back to the farm itself. What have some of the effects been on your land, of the practices that you use on the environment, and also on the food you raise? How do you work to achieve zero waste production? And what do you mean by that?

Well, the impact on the land has been incredible. When I started changing the way I farm, which means principally giving up tillage, pesticides, chemical fertilizers, and grazing my animals differently and having a broad spectrum of species of animals on the farm, it changed dramatically. My land went from a half a percent organic model - point five, one half of one percent - to five percent. A 10X increase, okay? It's incredible. And just to talk about the water holding capacity, I don't want to go too far down that hole, but 1% organic matter generally holds 27,000 gallons of water per acre. So, when you go from a half percent to 5%, a 10x increase, you can see what that does to the water holding capacity. The change is just as dramatic in terms of microbial life, and other aspects of soil productivity. So, it is incredible what it does. As far as the animals go, I had a monoculture of cattle, but I had a lot of them. And I always believed that our animal welfare was just great. I mean, I thought it was fine until I had my eyes opened and I realized that keeping them well fed, watered, in comfortable temperature range, is not good for the welfare. I thought it was, but it's not. It's also incumbent upon the herdsman to give the animals the opportunity to express instinctive behavior. Cattle were born to roam and graze, not stand in a pen and eat out of a trough. Chickens were born to scratch and pick. Hogs were born to root and wallow. And in the industrial model, those species don't get to do that. So, that's a beautiful thing to me. And then the environment, you know, I really believe that we're sequestering a lot of carbon. You mentioned zero waste. And when I say zero waste, I don't want people to think that there's never any plastic that's hauled off from here. Certainly, there is. But we slaughter our animals here on the farm, we've got a pretty big slaughter plant for red meat and poultry for private farm abattoir. And it generates about seven tons a day of packing plant waste. That's the term USDA uses. We compost that and make just wonderful compost that we reapply to the land. And it's just, it's just a beautiful thing.

That is beautiful. So, let's talk about the zero-waste concept. When people hear that, I think some people think that it means you don't waste any parts of the animal when it's being turned into food for human consumption. But you're talking about more than that. And you mentioned the carbon sequestration in the soil. Can you explain what that means and how that fits into the zero-waste idea?

I will but let me also address the fact that it does mean what you said. It does mean using all the animals. We render the fat into the lard and tallow, which we sell or make soap out of. The hides go to make raw hide pet chews, or I send it away to be turned into leather. We have a shop where we make leather goods. I can go on and on about the things we do to not waste. We grind the bones that are not marketable as soup bones. We grind them and apply them to the land as well as a source of calcium and phosphate. So, zero waste takes a lot of different ramifications to achieve that. And as for the carbon, you know, the carbon in our soil, the organic amount I mentioned earlier? Having increased this so dramatically is yet another way of not emitting. A company called Quantis, an environmental engineering company, did a lifecycle assessment on our farm several years ago. It's called LCA. And it's actually on my website, https://whiteoakpastures.com. And it shows that we sequester carbon. It's 3.5 pounds of carbon to sequestered soil for every pound that we put up. So, it's certainly doing positive things, we believe, for the environment.

That's so important, because otherwise that carbon would be up there in the atmosphere, creating a lot of damage that people know about. So, the fact that you're drawing it down, and sequestering it in the soil is doing a really good turn for our environment overall. Tet me say also, I love your website, https://whiteoakpastures.com, because it tells the story of what you do, it provides some history and resources about the farm, but also you have a lot of really pretty amazing products that you sell. And so, it's nice to know that these things are available to people who might be interested in buying the products for your farm.

It is so interesting and frustrating to me that a certain brand of environmentalist has identified cattle as being the primary culprit in climate change. And of course, it's simply not true. It is not fair to brand cattle with that claim, that, you know. If you want to blame the cattle feeding industry, confinement feeding industry with that, then I support it. But the way we raise cattle not only does it not contribute negatively, but it’s also part of the cure. And that's, it's just so unfair.

Let's think about the radical change you made in the family's farming practices. Tell me how risky this was? I mean, how risky was it to you in terms of your reputation, your place in the community with other people that may have been continuing to use all kinds of industrial farming and ranching methods, and financially, how risky was it?

That's a great question. And when I give the answer, I certainly don't sound very smart. Because there was a lot of naivety in the decision I made. I really did not understand how much risk I was taking on. I should have, in retrospect. I was just a little reckless. But I always ran the farm, and I'd always made money. I was going to change the way I run the farm, and I assumed it would continue to make money, but it didn't. I was adding value to the product I was producing, grass fed beef, that I was not able to extract from the market at that time. Partially because I didn't have processing available, and partly because grass fed beef had not come into its being in the consumer community. So, we had some pretty tough times, but we made it through it. And my timing going in the grass-fed business in that mid-nineties to early two thousands was so, so lucky. And I really, really do mean lucky. Today, I don't think we would've made it. There's too much imported grass-fed beef. That is labeled as "Product of the USA." The market has tightened and tougher because of that. We made it then, but I don't think we would make it today.

What does that say for farmers today who might be considering making the kind of changes that you made many years ago?

Well, I don't like reporting this, but I've gone from really being a recruiter urging people to embrace this kind of agriculture to really warning people, "Be careful." I don't recommend people not do it, but I really do focus on them being careful. And we sat up a 501 C3 called Center for Agricultural Resilience to help people learn the things that we've learned, so that they won't make a mistake. I really want people to farm this way. And my goal is not to grow White Oak Pastures. White Oak Pastures is as big as I ever wanted it to be. I never really intended it to be as big as it is. Growth is not important to me and my family. We've talked about it, and we're in agreement on that. But I do want to see regenerative food production grow. The way we farm is very cyclical, as opposed to the industrial food market, which is very linear. The food product system is very linear. And linear systems scale up really well. Cyclical systems, I think they kind of have a maximum level at which they perform well. And I think we're at it. So, my goal is not to grow White Oak Pastures bigger and bigger. Again, as a family, we've talked about it and decided not to. We don't want a business so big that we've got to hire a CEO to run it for us. We sell $25 million worth of products a year. And that's enough. It's bigger than we intended it to be.

Given that you said that it's not risk free to make this kind of change, and that people need to go into it with their eyes open, it seems to me, that there's a lot more attention now and awareness of regenerative agriculture. People in the general population know about it much more than they did even just a few years ago. And you have, you know, movies about it and television shows, and you have big institutions like the Rockefeller Foundation investing in it. I see that as a positive sign. I don't know if you do as well. But are there other things that can be done to create more inducements to farmers to make this change? Are there policies, for example, that might be put in place that would be helpful?

Well, and that is opposed to the multinational food corporations. There re only a handful of them, that are feeding the entire planet. And they're very linear, and there are many, many, many unintended consequences to their production system. It's really adverse to the environment, the land, the water, the atmosphere, the animals, and rural America. I can go on that on.

So, let's dive into that just a little bit. What can consumers do? Where do they look for their food? What do they look for? Where can they buy things? What can they do to help?

The things you said are certainly great positive signs. They're very, very, very good. But unfortunately, big food has focused on this market. And engaged in very, very talented, skillful greenwashing that tricks the public. And that's the impediment and that's the problem. I just don't know how it's going to come out. I used to believe that I was an early innovator in this new way of producing food that was better for the land, and rural America and the environment, and the animals. I was happy about it, very satisfied in it. And I still hope that's the case. But new, young, or old, a person who is moving from industrial commodity agriculture into what we do today, has a harder go of it than I had 20 years ago, because of greenwashing. From the consumer perspective, it's a lot better today. There are a lot more people talking about it, and a lot more general information out there among the public. But the multinational corporations that are tricking people, they're just very successful. When I called my book "Return to Giving a Damn," that was what I was referring to. That the consumer has got to educate themselves and see where their food actually comes from.

There are more opportunities to do that, I know. Where I live in North Carolina, there are a number of butcher shops around. And some of them in particular make it very clear that they're sourcing everything from local farms, and they talk about how the animals are raised, and they're tied into the kind of thing that you're talking about. So, it's nice that there are more such opportunities out there. And butcher shops seem to be one good place to go if you're a person who consumes meat.

That's a good question. And I think that the more locally you can shop, the better. We sell food online, and we ship to 48 states. And I don't want to. Now I appreciate everybody that's been buying from us. I'm grateful for it. Thank you. But I really want to sell my products to people in my geography. And I want people in the Pacific Northwest and the New England, and the other areas of the country to have producers, that they support, that are local to them, local food systems. I'm happy to sell anybody anywhere, but I'd really rather to help somebody get started. I will just say that.

It's nice that you offer your foods for sale online, because that does give people the opportunity to buy some of the things that you raise, and be connected with the story of the food that you've told us all about.

That is very pleasing to hear.

Say just a little bit more about greenwashing. How does it take place, and how can consumers know that it's occurring?

The way for consumers to avoid greenwashing, is also to know as much as you can about who you're buying your food from.

I hope the kind of education that you're doing, things like joining us, and writing your book will alert consumers to these kind of practices, and hopefully there will then be demand on legislators, change the way they write the laws to prevent this kind of stuff. But boy, it takes time, doesn't it?

Greenwashing is messaging. Big multinational food companies and Ag companies hire brilliant marketers to convey the message they want to convey to consumers about how the food is produced. And I mean, it can be as simple as industrial milk having these beautiful barns and meadows, and cows on the carton too, some really technical things that are done. But it allows industrial food to be sold under the guise of being very green and humane. Big multinational food companies can import grass fed beef from 20 countries. Uruguay, New Zealand, Australia, being the three biggest or almost prominent. And sell it as American grass-fed beef. Literally and legally label it "American grass-fed beef." If the animal was born, raised, and slaughtered in one of those other countries, it can be brought into this country and legally labeled by USDA, "Product of the USA." And that is the epitome of greenwashing, and it's so very wrong. But it is allowed if any value was added here. And that changed from when I first started selling grass fed beef in the early 2000's. That's not the way that rule read, the rule changed, and this was not an accident.

So, let me ask a final question then regarding that. Are you optimistic? If you look at the current generation of young people, do they care more about these things than what used to be the case? And do you think that leads to some optimism about what might occur in the future?

Well, it does, and there's so much money behind it. I think if the food production system in this country changes, it won't be changed by Big Ag, it won't be changed by the Department of Agriculture, it won't be changed by land grant universities. It'll be changed by consumers, and what they demand.

You know, it's so nice to hear that from you. And consistent with my own experience, you know, in the classroom, you know, I've been teaching people for many years. The most recent generations of young people seem very motivated around these issues, and informed and passionate. And I see that as a very positive sign for the future. So, I'm glad your opinion on this and mine converge. And there's reason I think to be hopeful for the future. So, Will listen. It was wonderful speaking to you, and the first time we did a podcast. And equally wonderful today. So I'm really grateful you could join us. And good luck with your work. And it's clearly inspired.

There is no doubt there's more enthusiasm and optimism among young people. In fact, we have an intern program. We only take six per quarter four times a year. And we get 20 something applications for the six openings every quarter. And it's incredible. And we don't push it, we don't advertise it, because I just can't have any more than that. But the number of young, smart, enthusiastic people that come through here, most of them do not come from agricultural backgrounds, is very, very heartening. That part is just great. So, many of our young people that came through here, have gone on to do really, really good things in other places. I'm very proud of them.

Bio

Will Harris is a fourth-generation cattleman, who tends the same land that his great-grandfather settled in 1866. Born and raised at White Oak Pastures, Will left home to attend the University of Georgia's School of Agriculture, where he was trained in the industrial farming methods that had taken hold after World War II. Will graduated in 1976 and returned to Bluffton where he and his father continued to raise cattle using pesticides, herbicides, hormones, and antibiotics. They also fed their herd a high-carbohydrate diet of corn and soy.

These tools did a fantastic job of taking the cost out of the system, but in the mid-1990s Will became disenchanted with the excesses of these industrialized methods. They had created a monoculture for their cattle, and, as Will says, "nature abhors a monoculture." In 1995, Will made the audacious decision to return to the farming methods his great-grandfather had used 130 years before.

Since Will has successfully implemented these changes, he has been recognized all over the world as a leader in humane animal husbandry and environmental sustainability. Will is the immediate past President of the Board of Directors of Georgia Organics. He is the Beef Director of the American Grassfed Association and was selected 2011 Business Person of the year for Georgia by the Small Business Administration.

Will lives in his family home on the property with his wife Yvonne. He is the proud father of three daughters, Jessi, Jenni, and Jodi. His favorite place in the world to be is out in pastures, where he likes to have a big coffee at sunrise and a 750ml glass of wine at sunset.

 As the parent of a 12-year-old child, I know that raising a child is one of the most profound and rewarding experiences of a person's life. It is also shockingly expensive. The high cost of child rearing is particularly difficult for families with limited resources. To help us think through this issue, it is my great pleasure to welcome a colleague here at Duke: Dr. Christina Gibson-Davis, Professor of Public Policy. Christina studies economic inequality, and particularly how it affects families with children.

Interview Summary

So, let's do a bit of level setting. We often hear words like poverty and wellbeing. For our conversation today, what is poverty in the US and what do we mean by wellbeing?

In the US we have a definition of poverty that relies on a certain threshold. Every year the US government publishes a set of thresholds for families that say - if you are below this threshold, then you are poor. If you're above this threshold, then you're not poor. The thresholds are actually based on data from 1963, when the federal government decided it really needed a way to count the number of poor people in this country. Prior to 1963, we really didn't have any way to do that. They looked at how much money people spent on food, and from that number, they derived these poverty thresholds. In 2022, the poverty threshold for a family of four, just to give your listeners some idea, was about $22,000. This means that if you earned $21,999, you were considered poor. But if you earned $22,001, you weren't considered poor. That's what I mean about the threshold and about falling either above or below that threshold in order to determine whether or not you're poor.

Thank you, Christina, that's really helpful. It is interesting that the measure of poverty really is centering on food, or at least traditionally has. We’ll get back to that in a moment. I want to go back to the question of wellbeing. Could you tell our listeners what you're talking about when you talk about wellbeing?

When we talk about wellbeing, we mean things like how healthy kids are, or how they get along with peers, or how they do in school. Basically, it's the way we measure how kids are functioning and whether they're functioning to the best of their ability.

It sounds like it's a broad notion that represents all the ways a child is a child, how they move in this world.

That's exactly right. It's going to cover a whole bunch of different areas. Everything from health and education to social relationships, to behavior, to delinquency, to how far they get in school. All of that goes into our definition of wellbeing.

Great. Thank you for that. I want to now focus a little bit more on children themselves. What does childhood poverty look like in the US?

We can have a technical definition of poverty, which is what I alluded to before, but really, that technical definition I don't think paints a very illustrative portrait of what it looks like to be poor in the US. To be poor in the US as a kid means you're growing up in an environment with very low levels of economic resources. You're probably growing up in a household where you're not sure if those economic resources are going to be enough for your family to maintain their home or pay their bills or get enough food. It's a very sort of unstable situation for kids because they may be worried that their parents just don't have enough money. It also sort of affects the kids' outlooks. We know that poor kids tend to have sort of lower aspirations or hopes for the future. Not that they're not hopeful, but they sort of also know that some of the things that they see may be depicted on TV that are open to other kids may not be an option for them; because they simply don't see a path between where they are and how they're going to get there.

That is actually pretty sobering. I'd like for you to explain something about households with children, and I noticed that a lot of our conversation is going to not focus on an individual child but about children in household context. So, how does poverty look different for households with children than households without children? Is there a difference?

Yes, there's a difference in poverty rates. One of the things that distinguishes poverty in the United States relative to poverty in other Western or developed countries is that we have very, very high rates of child poverty. And one of the biggest risk factors, in fact, for being poor in the United States is being a kid. Kids tend to have higher poverty rates than other groups. Why is that? Well, obviously kids aren't out making money. They're relying on their parents for their financial wellbeing. But it really has to do with the public policy choices that we've made. Your listeners have probably heard of Social Security and Medicaid, and those are two huge programs that make huge differences in the lives of say, people over the age of 65. We really don't have those kinds of corollaries for kids who are poor. And so, when you look at our policy priorities over the past, say half century, they've really been oriented more towards elderly people rather than kids. That's just a policy choice that we have made.

Thank you for sharing that. I know in some of the work that you've done, you've also looked at these issues through an equity lens. Can you tell us a little bit more about the wealth inequalities of households with children. And how does that work shape how we should look at child wellbeing?

We've been talking up until this point primarily about income, which for most people is the money that they earn through their job. We think about income as the money that flows into your house. There's also this really important concept, which is called wealth. Wealth is a household's assets minus its debts. So, for most households, their primary asset is their house. And then they might have debts because they owe money on their house, or they have medical loans or education loans or things like that. So, wealth in the US is distributed far more unequally than income. In particular, the racial gaps in wealth are staggering. So, in the US, for every dollar of wealth that is held by a white family with children, a black family has less than 1 cent. Again, that's a $1 to less than 1 cent ratio. When you have those kinds of inequities, it's really hard for some families to make a difference in the lives of their kids. We know that wealth really helps, for example, for kids to go to college or to make a successful transition to young adulthood. And when we have these kinds of race-based inequities, it really hampers some of these kids from realizing their full potential.

I know we have a number of colleagues like Sandy Darity who work on this racial wealth gap. So, this is a critical topic that has influence on how we need to think about these issues. And that's going to connect a topic that I have worked on, and that's a great interest of our center. It's the topic of food insecurity. Christina, can you help connect childhood poverty to food insecurity?

Food insecurity, as many of your listeners may know, is the ability to have enough food for a healthy, active lifestyle. Not surprisingly, being poor puts you at increased risk of being food insecure. It's probably the predominant risk factor for being food insecure. The reason we care about that is because we know that food insecurity has all kinds of detrimental consequences for children. So, we were talking earlier about wellbeing covering a wide range of outcomes. Food insecurity really diminishes kids' wellbeing in many of those areas that we were talking about. Kids who are food insecure are less healthy, they do less well in school, they may have more behavior problems. So, food insecurity is really something that can undermine the life chances of children.

I'm interested in now turning our focus to this issue of policy. We're at a policy school and I would like for you to talk a bit about what our current policies are for addressing food insecurity.

For children, there are a number of food programs in the US. I would say the three most relevant ones for children are SNAP or Supplemental Nutrition Assistance Benefits, and WIC, Special Supplemental Nutrition Program for Women and Children. And then there is a free and reduced lunch program. Those programs together really try to address food insufficiency among children. The evidence suggests that they work pretty well. None of them by themselves are going to reduce all food insecurity among kids, but they definitely lessen the levels of food insecurity that kids experience. 

There was an article in the "New York Times" about a year ago, the Fall of 2022, and it talked about readjustments to the measure of poverty, and they followed the family out of West Virginia. One of the things they did was they looked at the income that this family received, and it showed that 25% of the total, if you will, resources that came into this family were food-based programs, WIC, SNAP, and School Lunch Program. So, it's an important part of how families with limited resources are able to meet some of their needs. I'm appreciative of you sharing that.

I think it's absolutely vital, particularly when you think about families that may be living in places with really high rents. There's been a lot of talk lately about how the cost of housing has gone up, and really these sources of food assistance that they get from the government is just absolutely critical to helping them meet the basic needs of their families. So absolutely, these food assistance programs are just a linchpin of how these families survive.

It's interesting now that we're in this moment of debating the Farm Bill, which is the federal program that supports SNAP, how it's important for us to keep in mind that beneficiary of the SNAP program are children and children whose wellbeing can be affected by a program like this. I'm grateful for this conversation. Now, how effective are these policies at reducing food insecurity and addressing child wellbeing?

These programs work fairly well. They're not, I would say, large enough or convey enough resources to eradicate levels of food insecurity. I think it's also important for your listeners to know that there is no such thing as a federal food policy. So, we let states set the limits, for example, as to how much they're going to spend on SNAP. This leads to large variations in like the SNAP limits. So, for example, if you live in New York, you get about $100 more in SNAP benefits than if you live in Oklahoma. So, what does this mean? It means that these programs are going to be more effective in some states than in others, simply because of the amount of resources that people may get based on where they live.

As we wrap up, I wonder if you have any other points of consideration about policy and how policies that we currently have can actually help us address child wellbeing more effectively.

One of the other things that distinguishes the US food policy landscape, if you will, is we also have a relatively large private sector. So, people may be familiar with food banks or other places where they distribute food. And, you know, that's sort of the best and the worst that America has to offer, right? The best is that charitable organizations recognize the importance of providing food for people. And these organizations are very effective at providing meals and groceries, and it's a really important source for these families. But I say it's also the worst because there's a giant need for these private sector places. And because the provision of these private sector food goods can vary depending on where you live or how much money the nonprofit organization has, it can be a very variable source of support for food. So, in some ways, our food policy landscape is kind of a crapshoot, if you will. And that I think that makes it hard for us really to get a handle on childhood food insecurity.

Bio

Christina M. Gibson-Davis is a professor at the Sanford School of Public Policy, Duke University, with a secondary appointment in sociology. Her research interests center around social and economic differences in family formation patterns. Her current research focuses on the how divergent patterns of family formation affect economic inequality.

Diet-related disease such as cardiovascular disease and diabetes create a crushing burden on individuals, families, and the healthcare system in the United States. However, Produce Prescription Programs where medical professionals prescribe fruits and vegetables and health insurers pay, promise to improve nutrition and health. Today we will talk with Dr. Kurt Hager from the University of Massachusetts Chan Medical School and lead author of the largest assessment of Produce Prescription Programs to date.

Interview Summary

So, let's get into it. Before we dig into the study itself, can you tell our listeners more about Produce Prescription Programs?

So, the programs that we evaluated in our study gave participants electronic cards. So, either a debit card, a gift card, or a loyalty card that they could use at retail grocery stores and some farmer market partners as well to get free fruits and vegetables of their choice. The food could be either fresh or frozen fruits and vegetables. These programs acknowledge that nutrition education alone likely is not sufficient to increase healthier eating for many low-income households, for which just the cost of healthier foods is really the primary barrier in improving their diet. These programs seek to overcome that barrier, and it's really exciting to see that clinics across the country are turning to these. I think physicians, from our conversations with the clinics we partnered with in this study, are really excited to have a tool they can use and provide to patients to offer higher-quality care and help improve their nutrition when they're talking with their patients about managing diet-related illnesses like diabetes, hypertension, or obesity.

Thank you, Kurt. Could you tell me a little bit about why you and the team decided to do this particular study?

Food insecurity has been consistently associated with poor health outcomes, higher healthcare costs, and lower dietary quality. Many food insecure households tend to have higher rates of diet-related chronic illnesses. We worked with a wonderful organization called Wholesome Wave. They have operated Produce Prescription Programs across the US, and they have been collecting data on these programs for about five years now. Wholesome Wave reached out to our research team at Tufts University's Friedman School. They wanted to see if these programs are working at improving health outcomes. The key thing, I think, to contextualize where this study stands, is prior to this work, there had been a handful of studies that had shown, not surprisingly, that Produce Prescription Programs can improve dietary quality and improve food insecurity. However, very few had gone that extra step to see if Produce Prescription Programs were associated with improvements in really important clinical outcomes. Things like hemoglobin A1C, which is an important measure of average blood sugar levels in the past three months. This is critical for managing diabetes, and outcomes like blood pressure and obesity and overweight. Previous studies had found mixed results on these outcomes, and most had been very small, maybe about 50 participants. We built on this by doing the largest analysis to date. Our study had nearly 4,000 participants from 22 programs across the US, from 12 states. These ranged from cities like Los Angeles to Minneapolis, to Houston, to Miami, Idaho - so all over the US.

So, it was the fact that previous studies have had relatively small samples, and some of these other studies did not take all of the sort of important measures of health into consideration. So, you were able to build on that past work in a unique way in this study?

Exactly. I think the key thing is that Wholesome Wave had excellent relationships with their partner clinics. This meant that the clinics were willing to share medical record data with us. This is always just very challenging and many other studies weren't able to go that extra step. We were blessed with access to a lot of medical record data and we were able to do analyses that looked at important clinical biomarkers. I will say though, our study is a step in the progression. I'll be the first to admit, we did not have a comparison group in this analysis. So, the results that we found also could have occurred due to other reasons. Such as, for example, perhaps when someone is referred to a Produce Prescription Program, their physician might also make other referrals, or perhaps change their medications because this patient has been identified as high need. We certainly built on previous literature by having a much larger sample size and pooling data across the US, and to me, our findings really provide us with a strong rationale to continue research into this area. But also, to confirm our findings with randomized trials similar to what you would do, for example, for drug research.

That is helpful to hear. One of the things that's really important about what I understand of this study is the fact that you worked with Wholesome Wave, and that allowed you access to a lot of different programs across the US as you described. Could you give us a little bit of a sense of what some of those programs were, and how did they provide the support that you were able to study in this project?

Most programs provided the benefits on electronic card. It's similar to in WIC or SNAP, where participants have an EBT card, they can use it at retail settings. It's administratively very simple. From interviews among SNAP participants and other research, this tends to be lower stigma - when you're using a card at a checkout. These cards gave about $50 a month for six months on average for the adult programs, and $110 a month for the pediatric programs. Some of the children's programs were also a little longer. Some of the child-focused programs that we include in the analysis were up to 10 months.

So I understand from this description that the Produce Prescription Programs also look different. There were some programs for children, some for adults. How did you manage that? There's a lot of other things that could be going on. How do you sort of do that in this work?

Participants were referred to these programs because they were either food insecure or were recruited from a clinic that served a low income community and were very likely to be food insecure. Individuals also had a risk factor for poor cardiometabolic health. So, this means that they either had diabetes, high blood pressure, or were overweight or obese at baseline. That was really the common thread across all of these programs. We did all the analyses for adults and children separately. So, we report changes in fruit and vegetable intake, and changes in self-reported health status separately. Food insecurity - we did assess at the household level, but then for other outcomes, for example, hemoglobin A1C, we restricted that to the adult population that had diabetes when they enrolled into the program. For blood pressure, we restricted those analyses to adults with hypertension at baseline. For Body Mass Index, we restricted analyses to adults who were overweight or obese at baseline, and then did those same analyses separately for children for age and sex, only looking at children with overweight or obesity at the start of the study.

This is really important then. Thank you for that clarification. You know, you've talked about some of these critical measures such A1C for diabetes. You've talked about obesity measured in BMI. Can you tell us a little bit more about the importance of these findings and what they mean in real terms for participants' health?

Absolutely. So, we found that participation was associated with improvements in dietary quality and food insecurity. For example, among adults, they were reporting that they were eating, on average, about 0.8 more cups per day of fruits and vegetables by the program end. And food insecurity rates were cut by about a third. So, the program seemed to be working as intended, which was excellent to see. But then looking at the clinical biomarkers, for example, hemoglobin A1C among those with diabetes dropped by 0.3 percentage points. And among those with uncontrolled diabetes, those having chronically high blood sugars that are very difficult to manage, dropped by about 0.6 percentage points. So, to put that in context, that's about half the effects of commonly prescribed medications to manage high blood sugar levels. So, for just a simple change in diet, that is I think fairly impressive and very encouraging to see. And the effects on the reductions on blood pressure were also about half as large as we would see with commonly prescribed medications. I think it's really important to highlight that, one, we don't know if these changes will be sustained long-term when the program ends. There might be some participants where this program caught them in a moment of crisis perhaps, in which this helped stabilize them, and maybe they would be able to maintain these new improvements in dietary intake long-term. But I suspect many participants might not be able to maintain this healthier eating because the cost of healthier foods was the main barrier to healthier eating at the onset of the program. And so, this is an area that we're really interested in looking at in future research. But I will say, if one were to maintain these improvements that we would see in hemoglobin A1C, blood pressure, and BMI among adults, they really were clinically meaningful. And if sustained long-term, it could reduce risks of things like heart attack or stroke years down the line. Any reduction in these biomarkers can really have a meaningful impact on patient quality of life. Things even like averting diabetes complications with damage to the circulatory system, to nerves, to the retinas in the eyes and having vision loss. So, sustained long term, I think these really are meaningful impacts on health and wellbeing. The last thing I'll say, is for children, we did not see a change in BMIs for age and sex. I'm not too surprised, given it's a relatively short program on average six months. But also, child BMI is a notoriously challenging metric to move. But I do want to highlight that among the households with children, we did see an improvement in fruit and vegetable intake, and reduction in food insecurity, and self-reported rates of higher health status. And I think if we're thinking about childhood development, to me, that is still an important success. We know that having enough access to food in the household and having higher dietary quality is really, really important for childhood development and wellbeing. There's certainly a nutrition causal pathway here. But it's important not to forget that there's so much stress and anxiety when someone is experiencing food insecurity, about not knowing necessarily where your next meal is going to come from. Just worrying constantly about managing household budget, about trade-offs, say between buying healthier food, paying for medications, paying for other needs. So, I suspect these programs are improving health outcomes both through a nutritional pathway, but also through like a mental health pathway, perhaps reducing anxiety for some households as well, which can also have an impact on things like blood pressure.

So, given these results, it says that there's some important implications of these Produce Prescription Programs for the health and wellbeing of the participants in this study. I mean the fact that just changing fruit and vegetable consumption through a program like this had an effect similar to half the effect of some medications is really a powerful finding. I have got to ask, what are the policy implications of this work?

There is very exciting momentum across the US federal programs, promoting produce prescriptions and other forms of, for better or worse, what is known as food as medicine. And these programs all provide free healthy food to patients in partnership with the healthcare system or through a physician's office. So, Produce Prescriptions are the focus of this study, but the other Federal programs also include things like medically tailored meals, which are healthy, home-delivered meals, often to patients with even more advanced chronic disease who also might have activity limitations or disabilities that makes it really challenging for them to shop and cook independently. Last fall there was a historic White House Conference on Hunger, Nutrition & Health, in which the Biden administration in the summer prior engaged at a national level, major stakeholders in the anti-hunger space, large health systems, researchers, and government agencies to bring together a policy agenda to address hunger in the US, and the really high rates of diet-related chronic diseases. And it's important to note that, I think it is the first recommendation in the section of the final national strategy from this White House conference under the healthcare sector highlights Produce Prescriptions as a policy priority and expanding them in Medicare and Medicaid. So currently Medicaid, which is the federal health insurance program for individuals with low incomes or who have a disability, Medicaid is managed in partnership between each state and the federal government. And this means that states have some flexibility in how they manage their Medicaid program. They can apply for what is known as Section 1115 waivers. The federal government can approve these waivers if the state makes a good case that if they propose an innovative pilot, an innovative change, that they can make the case is likely to improve health outcomes and remain budget neutral, then the federal government can approve them to pilot this idea. So, currently in Massachusetts, we are several years into an 1115 pilot that is actually paying for produce prescriptions and medically tailored meals through the state Medicaid program. And currently about 10,000 people in Massachusetts have received some sort of nutrition support through the state Medicaid program. About 10 other states now have either similar waivers approved or pending approval to allow other Medicaid programs to do something similar. So, this is a really exciting area where expanding access to these programs is happening. And then in Medicare, which is the health insurance program for older adults, in Medicare Part C, which is the Medicare private health plans, those health plans can choose to cover Produce Prescriptions as a benefit. They're not required to, but they have the flexibility to offer that service if they would like. And then finally, I'll just say that there's also new pilots that were announced in Indian Health Services and the Veterans Health Administration. All these examples show that across the federal government there are exciting pilots and expansions occurring to cover Produce Prescriptions, and other foods and medicine programs. However, they remain unavailable to the vast majority of Americans who might benefit. And so, they're not a core component of any of those programs at the moment. And rather, these are pilots that are being tested, but very exciting movement, nonetheless.

Thank you for that really comprehensive set of examples of how policy is implicated in this work and potentially the need to expand this work. It makes me think of USDA's Gus Schumacher Nutrition Incentive Program. That would be another way that folks could access some of the benefits of federal dollars to support produce-type prescription programs. How do you hope to build off this study in future research?

At UMass Medical School, we're the official independent evaluator for the state Section 1115 waiver, which means we are essentially responsible for evaluating if things like the Produce Prescription Program in the Massachusetts Medicaid program is improving health outcomes. So, that is what we are working on right now. In our partnership with the state, we actually have access to all of the claims and encounters data within Medicaid. And we also are working with several health systems that are also sharing medical record data with us so we can evaluate the impacts of food as medicine programs on hemoglobin A1C, blood pressure, and BMI, so similar outcomes to this study. We actually have a large study funded by the NIH in partnership with former colleagues at Tufts University that is doing a deep dive on the Medicaid medically tailored meal program. And we're hoping to do something similar for the Produce Prescription Program in Massachusetts Medicaid. And the nice thing about these studies, they aren't randomized trials. Since this is a kind of a policy rollout, anyone who's eligible for these programs can receive the benefits. But we will be improving upon this study that we just published by leveraging two really strong comparison groups, and using some statistical techniques to make sure we're identifying patients who are as similar as possible to those who are receiving services, but ultimately didn't enroll. So, we're excited to have these results a couple years down the line and see if these programs are working in the context of a large state Medicaid pilot.

Bio

Kurt Hager is an Instructor in the Department of Population and Quantitative Health Sciences at UMass Chan Medical School. Dr. Hager’s interests lay at the intersection of structural determinants of health, food insecurity, and government nutrition and health programs. He is currently evaluating the effectiveness of the Flexible Services Program, which addresses food and housing insecurity in Massachusetts Medicaid. His involvement in state and federal policy initiatives underscores his commitment to translating science into policy, including initiatives with the Task Force on Hunger, Nutrition and Health and the National Produce Prescription Collaborative.

Does the term Policy Advocate conjure up the image of a chef? Today we're speaking with Katherine Miller, Founding Executive Director of the Chef Action Network, and author of the book "At The Table, The Chef's Guide to Advocacy". Katherine formerly served as the Vice President of Impact at the James Beard Foundation and serves as an adjunct professor at the Culinary Institute of America. She's worked for 20 years at the intersection of policy, politics, and social impact, and says chefs have an important role to play in this space.

Interview Summary

Chefs are more and more visible in this advocacy and policy space. I assume that they've been doing this for a long time, but you see more attention to it now, which is nice. Let's talk about sort of its fundamental concept of chefs being involved in the food system at this level. Why do you think chefs and other people in the restaurant industry are equipped to make the food system more just and sustainable?

I think that chefs are some of the greatest translators, right? Chefs, as we know them, are the people who cook us delicious meals or host us for events in our lives. But in reality they are taking the ingredients from the farmers and producers and fishermen and translating them to the plate to make them interesting and enjoyable for all of us, right? And the food system is incredibly complicated. It is deeply rooted. The root system overlaps and is incredibly complex. It's off-putting for people to think about how they might get involved in food policy or even understand the different controls on our food. Chefs can really help tell a better story, right? They can take the what's happening in the field and on the boats, and then they can put it on our plate, and they can help explain to us the stories behind all the food, how it's grown, the things that we should be interested in, the decisions that we should make differently. I think they're the ultimate translators and making the world a more delicious place.

That makes perfect sense! What inspired you to write your book, "At The Table"?

I've been working with the chef community for 10 years, first as a consultant and the founder of the Chef Action Network, and then working with the James Beard Foundation as the first vice president of advocacy and impact for the foundation. Then, after leaving the foundation, continued to work with organizations who are really interested in helping chefs step into policy arenas on things like healthy soils or food waste or medically-tailored meals. All those things are impacted by the policies that our state houses and our federal houses. And it's hard. The restaurant industry is enormous. There are 11 million or so restaurant employees. There are tens of thousands of people who are considered chefs or leaders in the kitchen, and we weren't going to reach them one Chef Bootcamp for Policy and Change at a time. You know, when I left the foundation in 2020 at the sort of tail end of the first year of COVID, we had over 1000 people on the waiting list to get into the Chef's Bootcamp for Policy and Change. We knew we were on to something, but we didn't really have the capacity to expand at scale. So, you know the great thing about a book is it can reach many chefs, culinary students, restaurant workers, farmers. And that's the other thing - I think there's a sort of duality to this idea of chef. It's really anybody who's a food system leader, anybody who is really interested in how the policies control our food system. I'm very excited to have a book out because I wanted this message and the examples and the tips and tools to reach the biggest audience that it could.

Boy, it's nice to hear there's so much interest among chefs and work of this type. I'm interested in whether this kind of thing is finding its way into culinary education. You have a position at the Culinary Institute of America, highly visible place. Is this the sort of thing that's showing up in discussions in culinary schools and classes and the training people receive?

More and more. I really credit Robert Egger for so many things in life, the great food system advocate and co-founder of DC Central Kitchen. But Robert was one of the first to write an op-ed that was like, culinary education should include advocacy, right? Because in culinary schools all over the country and all over the world, we teach people about flavor, we teach people about dish composition, we teach people about cleaning their station, and being a good person on the line, right? But we don't teach them about sustainability and that concerted way, we don't teach them business school skills and we don't really teach them about policies that impact their business, their sourcing, the way they run their restaurants. So that is growing. I think it's also a benefit of this next generation of chefs and consumers even who are really leading with their values. They want to see people step into this arena. The Edelman Trust Survey, which comes out every year, shows that food systems and food communities are some of the most trusted networks in the world. These leaders of that community have sort of a right, but also an obligation to get involved. The thing I like about the book and the thing I love teaching is that it's easy to do. It's not as difficult as you think it is, but I really think that the students and the consumers are demanding a sort of values-based approach. We're going to see all of the culinary schools add at least one class, if not more, of this type of training, I think in the future.

Let's go a little bit deeper into the bootcamp. You've directed the James Beard Foundation's Chefs Bootcamp for Policy and Change. Can you describe what goes on at the camp, and how this has affected your view on the chef's role in the advocacy world?

The Chef's Bootcamp for Policy and Change was an idea that Chef Michel Nischan and a James Beard trustee by the name of Eric Kessler had the idea for way back in 2012. They found me because I am a experienced trainer and facilitator. I've worked all over the world with, whether it be land advocates in Nigeria, health experts in China, folks in Australia, democracy in Lebanon, and they approached me and they said, “Hey, we have this idea. Chefs are highly visible. They are celebrities in their own right and we want to help them better use their voice.” That first bootcamp took place in July of 2012. We trained the first 15 chef advocates, and the penny sort of dropped for me that this was a community who are sitting in every single street corner. They have visible storefronts in every single community in America. They are trusted not to kill us, right? They are trusted to deliver something delicious and an amazing experience. They are networked heavily through the producers, both within their region and their city, but also globally in terms of what they source and how they buy. They have an authentic connection to fans, right? The bootcamp, which still continues to this day, trains 15 to 20 advocates at a time. The training module is still the same it was with a few tweaks in 2012. We really put them through their paces on introducing them to this food system and the complications of the food system. They also did role plays and learned techniques on how to be a better advocate. So how to create a message, how to reach out to their networks, how to use their social media profiles to talk about advocacy. And also, how to deal with the sort of haters of the world who might be like, "Shut up and get back to the kitchen". So, a little bit of that. Then the other piece that is so important to the entire food movement is created community amongst themselves. Every bootcamp ends with a dinner cooked by the chefs, for the chefs together with what they source on the working agricultural farm that would take them to. That community then spills out and it grows and grows. So exponentially, you could grow from 15 to 150 to 1000. They take it with them, they teach their staff, they host their own bootcamps or programming in their own cities. So, the bootcamp is one piece of it, but it's really about giving people the tips and tools they need to be an advocate, and then creating community amongst the chefs themselves and also their staffs and their greater community, and really just putting them into the places where they can use their voice to make a difference.

You know, it sounds really exciting! So, you have talked us through the process of how this education and training on advocacy and policy takes place. But let's talk a little bit more about the issues. Let's just say the Chef's Bootcamp was happening today and we walked in and we could overhear the discussions. What would we hear people talking about? Would they be talking about how children can be educated about food, about sustainable food systems and regenerative agriculture? Would they be talking about? state law, federal policy? What kind of issues would be important to them today?

Today? The Farm Bill, right? Chefs do advocacy in three places really. They do it on the table, right, through what they source, how they market to their customers, the types of labor practices they have in their own restaurant, like that is a self a form of advocacy. They do it within their community. So, a lot of chefs will get involved with local feeding organizations, will get involved with school gardens, things that they can put their hands on and bring people into their restaurant or visit regularly. I see a lot of community interaction. Then there's the hard and long work of state and federal policy reform. We are not going to be able to just uproot our entire food system and throw it out the window. Policy reform is gradual. It takes time and it takes a concerted effort. So, throughout each bootcamp or throughout different programs that I do, say with the Natural Resources Defense Council or programs that are run through No Kid Hungry, where alumni of the bootcamp have really gone on to shine is this federal policy piece. If you walked into a bootcamp today, you'd probably be hearing information about the Farm Bill, the impact of the Farm Bill on local regional food systems, the impact of the Farm Bill on food as medicine programs and SNAP programs, and really looking for ways a chef or a food system advocate could use their voice effectively to make the case for greater funding, to protect funding, to really encourage more progressive policies.

That sounds good. You brought up the Farm Bill, so let's talk about that in a little more detail. The last Farm Bill was passed in 2018, so it needs to be passed again now and reauthorized. Vast amounts of money are at stake for this. You mentioned that chefs can advocate for protecting funds that have been used in the past for particular purposes, and also argue for new uses of funds. What would be some of the top priorities? You kind of alluded to several of these, but tell us a little bit more specifically about what the chefs might be fighting for.

The Farm Bill is our food bill. I think we don't say that often enough. I think when we look at how the Farm Bill is constructed, we are looking at programs that are everything from specialty crops, i.e., fruits and vegetables, to the Supplemental Nutrition Programs that help people in times of need to not go hungry, to food as medicine programs that help us reach vulnerable populations with more fruits and vegetables at farmer's markets or medically tailored meals in hospitals or in systems. The Farm Bill reaches into all of those things. One thing I like to say about chefs is they're not monolithic. They're not all running around saying this thing. They are well-informed narrators and translators of a complicated food system and encouraging people to pay more attention to things like the Farm Bill and more things like the political nature of our food system.

If we want in the long term to redirect subsidies to support more climate smart agriculture, or help us have local and resilient food systems, that's going to happen through the Farm Bill. I was just recently with a bunch of chefs who were on Capitol Hill talking about healthy soil and the need to incentivize farmers through a bill called the Cover Act to help them change growing practices so that their soils would be healthier, and they could do more regenerative agriculture techniques. In a few weeks, there will be folks here really advocating to protect SNAP benefits. I think as we see a growing partisan divide and the growing divide on how to spend government money, SNAP, the Supplemental Nutrition Assistance Program, is always going to be a constant target of that.

There's a great anecdote in the book by chef Elle Simone, who talks very eloquently and proudly about the fact that at an early point in her life, she took SNAP benefits. She was broke, and she was financially insecure, and she needed help. She took those SNAP benefits at a time when she needed them, and they helped her complete her education and complete her path to the future. Now, she's a cookbook author and the first woman of color to be on America's Test Kitchen. She is a known celebrity chef around the country, and she wouldn't be there, she will always say, if it hadn't been for SNAP. So, somebody like Elle will come to Capitol Hill and tell that story to put a human face on a program that is often demonized by people who think there are other ways to spend money rather than make sure that people don't come hungry.

You know, there's a lot built into what you just said on lots of different levels. SNAP program, relationships with farmers, et cetera. Let's talk about farmers for a moment. I know that chefs have, of course, always had a strong relationship with farmers because that's where they secure what they serve in their restaurants, but it sounds like it's going beyond that. This alliance now is out there in the bigger policy arena around issues of regenerative agriculture and things like that. I'm assuming you've seen some interesting cases of farmers and the chef community coming together to argue for a common purpose.

Chefs and farmers are natural partners. There wouldn't be any food on our plates if there weren't for farmers. The types of food and the types of vegetables and meat, and even seafood, fishermen, the world, you wouldn't be able to put things on the plate without those humans. They produce amazing, delicious food, and they do it in ways that are better for the environment. It's nutritionally dense. So, they're a natural partnership, but they haven't always worked together. In part, because they had completely opposite schedules. The farmers are up at 5:00 AM and go to bed at 2:00 PM and you know, chefs are out until 5:00 AM, and at work, they haven't always been able to come together. But more intentionally, organizations are bringing them together. The Natural Resource Defense Council is working a lot with zero food print as a chef-led organization. Those two organizations are working in deep partnership to put chefs and farmers together regularly on Capitol Hill or in state houses, talking about things like the Cover Act, talking about regenerative agriculture, talking about the health that's contained in our soil and how that translates into healthier and more delicious food. They are natural partners, and I'm really excited that they seem to be coming together more on common issues that really are about putting healthy and delicious things in front of us all.

Well, it makes good sense that those kind of partnerships have evolved to where they are now. Let me ask you a final question. Well, let's just say I'm a chef and I meet you or people involved in this kind of sphere of work, and I'm thinking, boy, my life is pretty crazy. It's a high stress life, very long hours, lots of decisions to be made and people to supervise, and all kinds of stuff going on in these restaurants. How in the world would I have time to do anything like this? And then also, what are the actionable steps that such a chef might take to help create a better food system?

It's a great question, right? We're all really busy people. Everybody's calendar is full, whether it's kids or parents to take care of, whether it's jobs, whether it's volunteering, and we all look at our calendars, and we're like. How could I possibly fit one thing else in here? The number one tip I give chefs and anybody who really wants to be an advocate is you learn to say no first. You learn to look at what you care most about and decide that that is the thing that you are going to focus on. And all the rest of it, you're going to say no very politely to. So, in the beginning of work with chefs, I did an audit of dozens of restaurants and essentially chefs were being asked to donate on average about $50,000 each year to dozens of organizations in their local community and even nationally. When we think about that from a fundraising perspective, if you donated $50,000 to one organization, you would be a top donor to that organization. You would have a totally different relationship with them. I really encourage all of us, but especially the chef community, to take a deep look at the issue that drives you most, whether it's hunger, the environment, ending violence in our communities, mentorship, whatever it is. And really, one, pick that issue and prioritize that issue. Get to know the organizations and the experts that are already working in it, right? We all think that we're so smart and we must be the first people to have thought about X, Y, and Z, and you're not, right? There are lots of experts in the field, and there are now even experts in the field of chef advocacy. There are dozens of organizations actually in the appendix of my book that point you in the direction of different issues that you might want to get involved in. So, get to know the experts. And number three, take a baby step. Schedule an appointment with an organization, sign a petition, do some research. Just take a baby step into, okay, now I'm going to learn more. Now I'm going to do something. And it doesn't have to be a big thing. And then your advocacy will go from there. I'm a political activist at heart, and I want everybody to make sure that they're registered to vote, and vote because that is the ultimate form of advocacy and probably the biggest baby step that we can all take once we've picked an issue and become informed on that issue. There are other tips and tools in the book. I'm all about opening conversation, not closing conversation. So I really encourage people through the book and through some exercises in it to figure out their own narrative that opens conversation, their own set of questions that turns them into sort of active listeners and not lecturers. I think food certainly has enough judgment in it that it doesn't need advocates pointing fingers at each other, talking about how one's point of view is better than the others. It's really simple to get involved. The first step is say no. Pick the one issue that's most important to you. Do the work and get to know the issues and the experts. Take a baby step, register to vote, vote, and then you can grow from there.

Bio

Named an industry leader and “Fixer” by Grist magazine and called one of the most innovative women in food and beverage by Fortune and Food & Wine magazines, Katherine Miller was the founding executive director of the Chef Action Network and the former vice president of impact at the James Beard Foundation. She was the first food policy fellow at American University’s Sine Institute of Policy and Politics and is a Distinguished Terker Fellow at George Washington University’s School of Media and Public Affairs. Miller has built a 20-year career working at the intersections of policy, politics, and social impact. She develops and manages award-winning campaigns, trains activists around the world, and helps deliver millions of supporters – and hundreds of millions in funding – to efforts focused on global health, climate change, gender bias and violence, and food system reform. She is a member of the International Academy of Digital Arts and Sciences (IADAS) and serves on the Board of Directors of both the New Venture Fund and Re:Her DC. Miller is an adjunct professor at the Culinary Institute of America. She lives in Washington DC, on the land of the Anacostan and Nacotchtank people, with her husband, Lou, and their cat, Lily.

With record-breaking food prices in 2022, it has become more expensive for families to buy the foods that they need. The Supplemental Nutrition Assistance Program, or SNAP, helps families purchase foods but families frequently spend their benefits before the next benefit cycle. USDA modifies SNAP benefits every year as a cost-of-living adjustment. But was the change in fiscal year 2023 enough to keep pace with food price inflation? Today, we talk with Elaine Waxman from the Urban Institute to find out.

Interview Summary

You recently completed an analysis on the gap between SNAP benefits and the real cost of a meal. Can you tell us what you found?

Absolutely. I think it helps to start with the fact that for many households, SNAP is a supplement to their budget that they would spend on food. But for about four in 10 households, it is their food budget. In other words, they're deemed to have zero income available to purchase food. What we've done is look at how adequate is the benefit for those households, the ones that receive the maximum benefit. Given overall questions about SNAP adequacy, but because there's such wide variation in geographic food prices, something that I think we all know intuitively based on our everyday lives but don't realize that, in fact in the lower 48 states, SNAP is not adjusted for any of those differences in food prices. It doesn't matter if you live in rural Texas or rural Idaho or on the Coast, your benefit is the same if you're receiving that maximum benefit. What we find is that particularly, based on those experiences in 2022 that we all felt when we showed up at the cash register, 99% of counties in the US had cost for what we would call a moderately priced meal that exceeded the maximum SNAP benefit when we think about that on a per-meal basis. So that was very concerning obviously because people have been relying very heavily on SNAP throughout the pandemic. For a period, there were extra benefits, what is known as emergency allotments, but those have gone away now. As you mentioned at the start, we do get a yearly cost of living adjustment and it was pretty big last year compared to most years and it did help, but the maximum SNAP benefit did not cover the cost of a meal in 78% of count. So that's an improvement from 99% to 78%. But clearly, in the majority of the US, we're still not really able to fully tap the value of SNAP. And since SNAP is a big part of our strategy for reducing food insecurity, that's something we should all be concerned about.

I think this is really important for listeners to understand. There aren't regional adjustments in the SNAP benefits and there are huge price differences depending on where you are in the US. I know some work out of the Economic Research Service of USDA found that same finding in some earlier years. And so it's really important to see what happens, especially during an inflationary period. Thank you for sharing that. I want to talk about one way that we understand how SNAP benefits are set. And so, USDA updated the Thrifty Food Plan which is the basis of SNAP benefits or at least the maximum benefit level in 2021, and it was the first time since the mid two-2000s. What did that mean for the adequacy of SNAP benefits? And what do we know about how inflation has further affected SNAP benefits?

Yes, great question. It was a very important move on the part of USDA to implement that update to the Thrifty Food Plan, which basically is the market basket of assumptions about food purchasing that USDA relies on to set all SNAP benefits. So it's a critical piece of information. Even though it might sound like inside baseball, to some people, the Thrifty Food Plan really matters. As you noted, it had not been updated since I think 2006. And we all know that not only have prices changed a lot, but the ways in which we acquire food has changed a lot. We buy a lot more prepared foods even to eat at home. A lot more people are working and so the assumption that you can cook everything from scratch doesn't really hold for a lot of households anymore. a number of those assumptions were updated. And for a period, that made a big improvement in that SNAP maximum benefit that we just talked about. Unfortunately, that was eroded by the pretty unprecedented rise in food prices throughout 2022, which of course, partly relates to supply chain issues that emerged during the pandemic. The Ukraine war has certainly had a significant impact on food supply chains. The upshot was we had food price increases that we hadn't seen since the early 1970s. So that's where we were this time last year in terms of the maximum benefit, even with those improvements back to not covering the vast majority of counties in terms of cost adequacy. That cost-of-living adjustment helps somewhat, but I think the lesson we should take from this is that we have an underlying adequacy problem with the Thrifty Food Plan. It's really a bare bones assumption set, and a lot of folks have advocated that we move away from that to something that's called the low-cost food plan. It's a little bit more generous. It's a sort of bare bones basic shopping, but the Thrifty Food Plan may just not be the right template anymore. And if we want to tackle the persistent issue of food insecurity in this country, we've got to deal with this underlying SNAP adequacy issue.

I think this is really an important issue. I want to push a little bit further on the Thrifty Food Plan itself in terms of what it means. Please correct me if I get it wrong. It's this idea of a least-cost diet that is nutritionally adequate. It's looking at the dietary guidelines to help provide constraints to make sure people are eating a nutritious meal and it's also based off a minimum cost expenditure for what that diet would look like. It's based off a family of two adults and two children, and it doesn't incorporate lots of different family structures. Is that a fair assessment? And are there then some concerns about what the Thrifty Food Plan is?

I think what you're suggesting is basically correct and one of the issues about the Thrifty Food Plan is that when it was first developed, it really wasn't envisioned as a sustainable diet. It was really more of an emergency sort of meal plan. Like you're very strapped for resources, you can provide minimal nutrition for your household. But this is not what we want for people on an ongoing basis. One of the problems about the assumptions in the Thrifty Food Plan has also been that when we think about a household of two adults and two children, well, children eat really differently depending on their age, right? A five-year old doesn't eat anything like a 15-year-old. There are a lot of issues around household composition, but also just what do we mean when we say we want nutrition security for people, right? We want people to be able to eat healthfully in a sustaining way and I really think our ongoing look at SNAP adequacy suggests we're not there. We're not leveraging the tools we need to tackle not only food insecurity, but the fact that we have an epidemic of chronic diet-sensitive disease in this country.

Thank you for that. You know, this raises important questions about policy frame and the policy space around food access and food security. The Farm Bill is usually the legislative vehicle for making major changes to SNAP. But this past spring, the debt ceiling debate negotiations resulted in adjustments in the SNAP work requirements for some groups and new exemptions for others. What changes were made? And more broadly, what does research tell us about the impact of work requirements and time limits?

It's been an interesting year, to say the least, for the progress of the Farm Bill. Just to remind everybody, the Farm Bill is that place that we normally make major changes and reauthorize significant federal nutrition programs like SNAP roughly every five years. This year, the debt ceiling negotiations sort of preempted a lot of the ongoing discussion in preparing for the Farm Bill, because it took up this issue of time limits specifically focused on benefits for what we call individuals who are able-bodied adults without dependents. Sometimes, you'll hear the term ABAWD. I prefer not to use it because people are not the policy, but it's really focused on single adults who don't have custodial children. The idea is that if you are not able to meet a minimum work requirement of 80 hours a month or equivalent activities, you are limited to three months of benefits in a 36-month period. So that's extremely draconian, especially when we think about what we all know about the instability of low-wage work, right? And in periods where we have widespread unemployment, like we did for a bit in the pandemic, we have the ability to waive those requirements for everyone but they are now coming back. In addition to them coming back, they are now being increased in terms of the number of people it will cover based on the debt ceiling deal. It used to be folks 18 to 49. It will phase in now for people up to age 55, which is also an interesting thing. Because as people age, they sometimes have less ability to be flexible in the workplace and to move into new positions. There's a whole another conversation we could have about that. I guess a bright side of the debt ceiling bill was that it also created some new exemptions for those requirements, and they were focused on very specific groups including veterans, people who are unhoused, and young adults moving out of foster care. So those are all groups that we know are particularly vulnerable when it comes to just monthly finances and their ability to engage in the workplace. And that's a good thing but it doesn't mean that there aren't lots of other folks out there who have other significant challenges that ought to be recognized. And because it's a very sort of discretionary kind of process, we don't even have confidence that everyone in those groups we just talked about would actually receive a waiver. So why does all this matter? It matters because there's quite a body of research now that suggests that these time limits and work requirements don't do what they set out to do, which is to meaningfully increase either work effort or household income. They don't really accomplish the stated goal. They also cost money because you have to administer them and have a lot more interaction with the clients. And not only then do they not achieve those work goals, but they actually push a lot of people off of SNAP and/or trim them through, as we call people who move in and out because of administrative problems. What we have is a group who already has higher than typical food insecurity rates. We're making it more difficult for them to engage in SNAP. And SNAP is our number one tool for reducing food insecurity from the federal program portfolio. On balance, I think a lot of folks in the food security space would argue that time limits should just go away, right? That's not where we should be putting our investment if we want people to have more self-sufficiency and if we want them to eat better.

I really do appreciate the way you are humanizing the experiences of individuals who may depend on SNAP, but as the new policies are being implemented, may age out in a strange way. This is really a useful way for us to understand the implications of when we make decisions or changes to policy, it can have really negative consequences and may not achieve the goals that are at least stated. This is an important part of this conversation. But we're looking at a federal shutdown and if an agreement isn't reached, we could see some serious implications for families. Some lawmakers are calling for across the board cuts of most discretionary spending programs as part of any agreement. Would those cuts affect federal nutrition programs?

Good question, so the short answer is it's just going to be generally disruptive across the board, but the type of program does matter. So SNAP is what we call an entitlement which means that anybody who is eligible for it will receive those benefits on an ongoing basis. But another very important program that many people are familiar with is called WIC and that is a program focused on prenatal care and postpartum care for moms and infants and children up to the age of five. WIC reaches millions of children across the country, and it is not an entitlement program, which means that it's subject to an annual budget. We already have a problem with the WIC budget this year because we've had bigger increases in enrollment than were expected. I think that speaks to this issue about the continuing pressure of food prices, the loss of other pandemic supports at a time when families are still struggling to navigate basic needs. We've had more pressure on the WIC program and there was already concern that there would not be sufficient funds, let alone going into a shutdown situation. The administration has estimated that there will be a significant impact on families who will not be able to receive WIC if the shutdown were to persist. And then the bigger issue is that the time that we invest, so to speak, in shutdowns is time we're not working on the Farm Bill and having a thorough reassessment of program needs. It's likely to delay the Farm Bill agreements as well. While shutdowns, you know, are obviously very much about politics for people who have to put food on the table every week, some of which are paid for by federal salaries, right? Then this is a very real economic shock and it's unfortunately an economic shock that we could avoid.

Yes, it is important to think about how we can avoid this and reframing this as an issue about politics. But at the end of the day, there are families who are dependent on these policies, and we just had a conversation with Travis Smith at the University of Georgia about what happens when kids roll off WIC and that sort of in-between time before they enter school and that had this negative effect on the nutritional quality that these children consumed. And you can imagine that if there are disruptions in WIC while it's a smaller program than SNAP, it has important implications for the wellbeing of the families that use it. This is an important time and I'm hopeful that we will move past this impasse. Discussions about how to strengthen healthy eating for the US population are ever present. And this is particularly true for those individuals who participate in the SNAP program. What proposals are being considered for SNAP and how could we see any of those in the Farm Bill?

This is a really important topic because we actually have an evidence-based strategy for increasing the ability to purchase healthier foods like fresh fruits and vegetables and that is what they call nutrition incentives. Some people will know it as Double Up Bucks, but basically, they're programs that allow people to receive additional money for SNAP if it's put towards those kinds of purchases. That's something that's been evaluated over the last several years and seems to do exactly what we want, which is to increase those purchases. Unfortunately, it's a grant program. It's not an integral part of SNAP. It very much depends on where you live and what year it is as to whether you can access that kind of program. We're underutilizing a tool that's already there and the Farm Bill does currently reauthorize that grant program. Some people will maybe know it as what's referred to as GA/SNAP grants. But we did an analysis and showed that while they do a good job of targeting GA/SNAP grants to areas of high food insecurity, there's still lots of high food insecurity areas that don't have one available, and they're always time limited to a few years. We're not using the knowledge that we've already gained to accomplish this goal again that we're beginning to talk about, which is to really focus on nutrition security and not just basic adequacy of diet. The other thing that people often raise is, well, perhaps we should restrict purchases of certain kinds of benefits. And I think, in general, we find that Americans don't respond well to those kinds of limitations. And a concern, I think, that the food security space has about restrictions is that it's potentially very stigmatizing just to low-income people who are using a benefit when the truth is that most of America doesn't eat as well as we need to and that's a larger structural conversation. The upshot is some people would advocate for restrictions on things like soda and candy, maybe other snacks. I think we could all understand why we wouldn't want to prioritize that, but the fact of the matter is that restrictions don't make the other things more affordable, and that is exactly what the nutrition incentives are intended to do.

Bio

Elaine Waxman is a senior fellow in the Income and Benefits Policy Center at the Urban Institute.  Her expertise includes food insecurity, food access, federal nutrition programs, social determinants of health and broader issues affecting families with low income. Waxman previously served as the Vice President of Research and Nutrition at Feeding America. She has co-authored numerous publications, including an article on SNAP benefit adequacy in the Agricultural and Resource Economics Review, which was named the journal’s Best Paper in 2019. She received her MPP and PhD from the University of Chicago, where she is a lecturer at the Crown School of Social Work, Policy and Practice.

A diversity of bacteria and microorganisms making up the gut microbiome supports both our physical and our mental health. Research has shown that stress and trauma can negatively impact the microbiome. But a recent study took that finding to a new level. This was a study published in the Proceedings of the National Academy of Sciences. Scientists now see inflammation-related microbiomes in babies born to women who experienced mistreatment or adversity during their own childhood. These microbiomes predispose children to physical and mental health problems. We'll talk today with the co-author of that paper, Fran Querdasi, from the University of California, Los Angeles. Interview hosted by Kelly Brownell.

Interview Summary

This topic is so important, and you just hear time and time again from experts all around the world how profoundly the microbiome was influencing our health and how many factors affect the microbiome. But now to think about this generational matter that you addressed in your research is interesting and scary, in a way. Let's first start off with this question about how you studied these mothers and the children. What were you looking for?

The goal of the study was to see how experiences of adversity or hardship across two generations might be related to the composition of the children's gut microbiome, or in other words, which microbes were living in their guts. So, for this paper, I worked with colleagues at the University of California-Los Angeles, as well as a team of scientists in Singapore who are currently conducting a big birth cohort study called Growing Up in Singapore Towards healthy Outcomes, or GUSTO for short. That study has thousands of mothers and families enrolled but, in this paper, we focused on around 450 families who had data on what we were interested in - the mother generation, as well as her child generation. We specifically wanted to study the children when they were around two years old because the gut microbiome develops really rapidly during that period from birth until around two years of age. 

In this study, we asked mothers to tell us about three different kinds of adversity. First, their history of maltreatment. That would be things like abuse and neglect in their own childhood and then kind of moving forward in time, any symptoms of anxiety during their pregnancies. Then moving forward again into the children's generation, their children's exposure to stressful life events. So, things like their parents' divorce or the death of a family member from birth till two years of age. At two years of age, we collected poop samples to analyze the children’s microbiomes. Then we also asked families to report on their children's social emotional problems. So, things like aggression, sadness, issues with attention on when they were two years old and then again at age four because we really wanted to see also how their microbiomes were related to their early childhood health.

I'm eager to hear what you found but first, let me say I'm impressed that you even bothered to ask this question because one wouldn't think that traumatic experiences decades ago in the life of a mother would affect the microbiome of a child today. So, tell us, please, what did you find?

We found that each of the adversity experiences that we asked about - so abuse or neglect that the mother experienced in her own childhood, the mothers' symptoms of anxiety during pregnancy, as well as children’s experiences of stressful events in their early life - all of those seem to have an impact on the children’s gut microbiomes. Specifically, we found something interesting, which was that some of the microbes that seem to be related to adversity we think that they might perform similar functions to those that we found were related to the children's social emotional health, both at two years and then at four years of age. We think that those microbes probably play a role in regulating the immune system and inflammation. Our findings kind of hint that maybe disruption to some immune-related functions within the gut could help explain how some children go on to develop mental health struggles after they experience adversity. And how that intergenerational experience of adversity shows up in subsequent generations.

Like I said, it's hard to imagine that things so distinct in timing can have such a big impact. How is it possible that adversity experienced by a mom in her own childhood could affect her child now in terms of the microbiome?

That is pretty surprising. You think that it's so far in the past, but it's really striking that it does still appear to have an impact. This study was the first one to find evidence for that in humans. There have been studies in animal models, researchers that work with rats and mice, and there was evidence the mom's experiences during childhood affect their children's gut microbiome. There is other research that studies this phenomenon, called intergenerational transmission of adversity, and that's when trauma, chronic stress, adversity, those kinds of experiences experienced in one generation have impacts on the following generations. Even in those who have never directly experienced the event. Research has brought up many possible explanations for why that might happen, from changes to gene expression after adversity to changes to the parent's health and behaviors. In terms of the microbiome specifically, it's possible that the mother's health or underlying biology and physiological response to stress was affected by that adversity that she experienced in some way. And that shaped her child's development in terms of brain or stress response systems during her pregnancy. Then, because the microbiome is really connected to other biological systems that had an impact on the microbiome, the mother's microbiome plays a big role in shaping the child's initial microbiome during birth, and then after birth in terms of contact with the child and breastfeeding, things like that. The bottom line is that the mother's microbiome was affected by her adversity and then directly shaped the child's microbiome.

A fascinating set of possibilities you're talking about. Let me ask you a down in the weeds question. How can you isolate the impact of the adverse childhood experiences in the mother in terms of its impact in the microbiome from other things that just might co-occur with the adverse childhood experiences, social disparities, economic disparities, health disparities in general and things like that?

That is definitely really challenging to do, and we did that to some degree in our study. There's definitely a lot of future research that needs to be done to tease apart the different factors that might play into that relationship between the mother's adversity in childhood and her child's microbiome. But we did account for the mother's socioeconomic status in terms of the family's income, and we also accounted for the birth mode of the child, so whether the child was born by C-section or vaginal birth. So, in that sense, we tried to isolate the impact of the mother's adversity.

That makes sense. It sounds like you took care to address that issue. Now let me ask a question about what can be done given this relationship you found. Is there anything that can be done to disrupt this connection? One might think perhaps if the mother had eaten a diet that was specifically designed to optimize the microbiome, would that help, for example?

That's a really important point. There are many things that impact the gut microbiome in addition to adversity experiences. Diet, other things in the environment like exposure to nature and other people, the urbanity of your living environment and overall stress levels as well. That also highlights that many things can be done, both on an individual and societal level to promote a healthy gut microbiome and possibly counteract or mitigate impacts based on adversity. We're very far away from knowing exactly what the perfect way is to address this because there's just so much more that we need to know about the gut microbiome. But there are some general things. We know that eating a variety of foods that have a lot of fibers like fruits and vegetables, that's good for your gut microbiome. So, policies that make those foods more widely accessible and affordable. And then things that can help you manage stress in a healthy way. So, meditation, exercise, really strong supportive social relationships, as well as policy supports for families that reduce financial stress and precarity. Then, in terms of focusing on specifically early life policies that allow parents the time to form positive relationships with their kids, like parental leave and things that help maximize the mother's health broadly. So, affordable perinatal care can set the child up for the best possible start to life. Those are changes that would promote microbiome health broadly in addition to overall health.

Those things all make sense. And the good news is that every one of those things you mentioned would have health and mental health benefits way beyond the microbiome. So, good reason to focus on those things. Now let me ask you one final question. Are you working on follow-up studies to this?

Yes, we are. So, in that study, as I mentioned, we were looking at microbiome composition, which means which microbes live in the gut. We found evidence suggesting that immune functioning was really important, but the methods that we used were not able to test the function of the microbes directly. So, we're following up on this work by looking at the same questions of how adversity experiences impact the microbiome but looking at function of the microbes directly. So, in this group of families that we studied, as well as others, I'm also interested in looking at how adversity might impact communication between the immune system and the gut microbiome. The gut microbiome is really intimately connected to other systems. For example, there's many connections between the gut microbiome and the brain and the brain and gut microbiome influence each other. I'm looking at communication between the gut microbiome and brain as well. So, trying to get a more complete and whole-body picture of the processes that are affected by adversity and if those changes relate to mental and physical health and kind of the specifics of how that works and I really hope that that work will open up new ways to treat and prevent health problems in families exposed to adversity.

Bio

Francesca Querdasi, M.A. is a PhD student in developmental psychology at the University of California, Los Angeles, with minors in health and quantitative psychology. Her research focuses on understanding how experiences of adversity or hardship predispose individuals to develop physical and mental health problems, with a particular focus on depression, anxiety and chronic pain disorders. Her prior work has examined the intergenerational transmission of adversity by way of the gut microbiome, and how adversity is related to communication between the brain and gut microbiome in early childhood. In the future, Fran plans to examine the role of the immune system and immune-gut microbiome communication in the development of mental health problems during the teenage years. The ultimate goal of Fran’s work is to inform new prevention and treatment strategies that promote health and well-being for children and families impacted by adversity.

I read a study recently featuring a term I had not heard or seen before: "disproportionate beef eaters." The study was done by Dr. Amelia Willits-Smith, Diego Rose and colleagues at Tulane University. So, who are such beef eaters and how are their consumption patterns associated with environment and climate change? Today we're joined by one of the authors of that study, Dr. Diego Rose, who is a professor and nutrition program director in the School of Public Health at Tulane. 

Interview Summary

You, your colleagues, and your students do the most interesting work on really important issues, such as how diet lies at the intersection of health and environment. This sort of work is so important because there's a lot of talk about it. But not enough empirical work to really make policy decisions has been done, at least regarding some questions and you're helping fill like gap. I'm really delighted you could talk to us today. Let's start talking about this study. Give us some context if you would. Why did you set out to study the characteristics of disproportionate beef eaters?

Kelly, I've been doing this work for about seven years - working on a connection between diet and climate change. In the early days when I would do presentations on this research, I would always start the presentation with a slide or two of some big government report or intergovernmental report. Sort of legitimizing the whole topic. Now I find that climate change is so connected to people's daily lives whether it's the floods and the heat waves, droughts, fires that that are happening that people know it's a problem. I don't need to preface what I'm saying by that. When people think about climate change, they tend to think about it being caused by the transportation sector, perhaps energy use or construction but they don't tend to think about food systems. But it turns out that human food systems account for a third of greenhouse gas emissions. Most people don't think about that. Within that category, livestock is the most important contributor to greenhouse gas emissions. What's more, within livestock it's beef. Beef, it turns out, accounts for eight to 10 times more impact than chicken and over 50 times the impact on greenhouse gas emissions than beans. Naturally, we were concerned about beef. If we were going to do an education campaign to let people know about this, we thought, well, who should we target it to? We should target it to the people that are eating the most of it. And how you would target that? Well, you would set a threshold for what's disproportionate beef consumption and then go about looking at some data to see who's contributing the most to beef consumption.

That makes perfect sense. Let me ask you sort of a fundamental public health question in this context. Sometimes you get a big impact at a public health population level by making big changes in people who are the biggest users of something. Heavy smokers would be an example or heavy drinkers. That's the approach you're taking here. But I know in other cases some people have said that with some consumption patterns that are hard to change, like maybe what people are eating or smoking or drinking, that it makes sense to focus on a different part of the population where you get smaller changes but spread across a larger number of people who are more willing to change, and hence you get a bigger impact. So how do you define who were the disproportionate beef eaters and what were the findings of the study?

To think about disproportionate beef eaters we used the dietary guidelines for Americans. We looked at the healthy US meal plan. The data we had was on daily intakes. That meant that for somebody with a 2200 calorie consumption level that a recommended amount would be four ounces for meat, poultry, and eggs. We thought, well, if you're exceeding the recommended amount with just one of those foods, say beef, where you could be meeting the recommendation with chicken or eggs or even vegetarian if you wanted to, we thought that was disproportionate. So, we used that as a benchmark, for a disproportionate diet. So, what did we find?

Before you do that, let's give people some sense of this. When people talk about a recommended serving of meat, they say something that might be about the size of a deck of cards. Is that four ounces you're talking about? I'm imagining you're talking about people that eat multiples of that.

You can think of four ounces as a quarter pounder, thinking about a burger, except that it's cooked weight. Usually when McDonald's puts out a quarter pounder, that's the raw weight. We're really thinking about one and a quarter or one and a third quarter-pound hamburgers. That's what the threshold is. So, if you're eating more than that, more than one and a quarter, quarter-pounders a day every day, that's what we're considering disproportionate.

Okay, thanks. So, now tell us about what you found in your study.

We found three kinds of things in the study. First, that 12% of people consumed this disproportionate amount of beef. They were more likely to be men, they were less likely to be young people under 30, or older people over 65. They're also less likely to be college graduates. So, those are the kinds of things we were looking at when we went into it. The other things that we saw were that those 12% of people - and this is what really surprised us because we weren't looking for this, but what ended up happening - the 12% of people that are disproportionate beef eaters are consuming 50% of the total beef on any given day. That was the surprise. That's the one that's got all the headlines. There's another piece in there that didn't get as much play, but I think it's interesting. When you think about beef, you tend to think about a steak on my plate or maybe there's a burger on my plate. But the truth is over 50% of the total beef that we saw consumed was in the form of mixed dishes. I'm talking about stews and soups and burritos and tacos and sandwiches and pasta dishes. That was the other finding - a lot of the beef that's been consumed, a majority of it, is consumed in these mixed dishes not just on a hunk of beef on the plate.

Those are really striking findings that 12% of people eat 50% of the beef. And that it's clustered in certain demographic groups! Really pretty interesting. I also am surprised by the mixed dishes because the vision of my head as we were speaking is that people eating the hamburgers and steaks and things like that. But the mixed dishes are really an interesting part of the picture. So, what do you think some of the factors are that drive meat consumption in some of these groups? 

It's interesting. I think young people are more concerned about the planet in general. They are more clued to these issues and that might be part of the reason they are eating less beef. I think older people might be eating less beef because they're concerned about health issues. We haven't talked about that. There are a number of studies, and it is pretty consistent evidence showing that the connection between red and processed meats and heart disease and mortality. I think older people might be more concerned about that and therefore eating less meat. College graduates may be just understanding these connections better, possibly. That is part of it. I think men over women because there are some studies that show that meat plays into masculinity. There is also the idea that men are more willing to sacrifice animals for their own good than women are. These are some studies in the psychology of eating. We don't do this kind of work, but I think it's interesting.

From my own observations, and this is in the past more than I've seen it currently, but there was a time when the fast-food companies especially were reacting to messages that eating meat wasn't very healthy. The kinds of messages that they were putting out at the time were, don't let anybody tell you what to eat. Be a man, stand up, eat our massive burgers. I imagine that all these things are linked together, aren't they? The marketing practices, the masculinity, the imagery all of it's a pretty complicated set of topics.

It is. I think they are connected as you pointed out. That makes it all the more challenging to try to do something about it.

So, back to your study now. What do you mean by eating a disproportionate amount of beef? I think you defined it already, but is there more to say and how do you translate your research definition for the public who might be interested in their own consumption patterns?

That's an interesting point because we do our research and then we have the challenge of trying to communicate it to the public afterwards. Part of that is there are different concepts. What we do in the research setting is not necessarily related to what you would do at home. So, let me describe how that is. For example, in this study, we're looking at 24-hour recall data. This is a tool that nutritionists use to get a snapshot of what someone ate on the previous day. And they're very comprehensive. There's a whole methodology around it to get what is in that day's food intake. And that's what we have in our study here. The National Health and Nutrition Examination survey which we use is a nationally representative survey. So, we have over 10,000 adults here that we're looking at a snapshot in the day. And so, when we're trying to set up a threshold for what's disproportionate, we take a look at the dietary guidelines for Americans and translate those into one day. That's where we got these four ounces of beef more than that would be disproportionate. Then the question becomes, well, what do you do if you're a consumer? Can I eat a burger and not reach the disproportionate level? Yes, on a given day. But the way that the guidelines are set up is across a whole week. So, really the way to think about it is disproportionate in your daily life would mean eating a burger and a third or more every day, not just on a given day. 

That makes perfect sense, so I appreciate that specific advice. What are the connections between consumption patterns that you're describing and agricultural emissions and climate change?

This idea of a dietary carbon footprint is what are the greenhouse gas emissions inherent in the foods you eat? It's not the eating that's the problem, it's the producing. That is where most of the emissions come from. How does eating affect emissions? If you eat less of something then the idea is that will send a signal back to producers to produce less of it. So, to the extent that emissions are coming from the production side and you are not participating in that, this would send a message to producers to produce less of it. Now if that link is broken, for example, and it can be broken, if American Beef Producers export which they do, then it doesn't help the planet. In other words, if they keep producing beef and shipping it to Indonesia or someplace else then it's not enough for us to eat less. It has to be a sort of a global effort.

It does make good sense when you state it that way that a lot of people making these kinds of changes could add up to a big difference, given the role that beef consumption is playing in agricultural impact on the climate. I appreciate you focusing on that. What would you say is the broader importance of this topic? 

Diego - I think really the broader importance is to point out that beef is a really extravagant source of protein. You can get the same nutritional equivalents, even better because it doesn't come with saturated fats, not associated with cardiovascular disease to the degree that beef is. If you were to eat chicken, it’s like one-eighth or one-10th the amount of greenhouse gas emissions to produce chicken than it is beef. If you go vegetarian, even more so. I think the significance is that there are little changes that can be made that would add up. And they can come in from lots of people and they can come in lots of ways in anyone's diet.

Bio

Diego Rose is professor at Tulane University’s School of Public Health and Tropical Medicine. His research explores the social and economic side of nutrition problems, with a focus on nutrition assistance programs, food security, and the food environment. He has studied disparities in access to healthy food in New Orleans and has developed a framework for how the neighborhood retail food environment influences dietary choices and obesity. His latest research projects examine grass-roots efforts to improve healthy food access in New Orleans and the environmental impacts of U.S. dietary choices.  Dr. Rose has served as a consultant to the UN Food and Agriculture Organization and the World Food Programme. He teaches nutrition assessment and monitoring and food and nutrition policy. Prior to joining the faculty at Tulane, he worked for USDA’s Economic Research Service on domestic food assistance policy and in Mozambique and South Africa on food security and nutrition. He began his nutrition career as the director of a local agency WIC nutrition program in a farmworker clinic in rural California.

The third largest food assistance program in the United States is the Special Supplemental Nutrition Program for Women, Infants, and Children, or WIC for short. WIC is designed to safeguard the health of low-income women, infants, and children up to the age of five who are at risk of inadequate nutrition. WIC provides funds for specific foods to supplement diets, information on healthy eating, and referrals to healthcare. However, regardless of school attendance and access to school meals, children age out of the program the month after their fifth birthday. Today, I am talking with the University of Georgia's Travis Smith, an agricultural economist who, along with his co-author, Pourya Valizedah studied the effects of aging out of WIC on children's diets.

Interview Summary

Before we discuss your recent paper, why did you decide to study aging out of WIC?

There's been a lot of work on pregnant and postpartum women participants of the WIC program, and also infants, and all of that research is definitely very important. There's been less work on child participants, and one thing we were interested in was this arbitrary rule about kids losing access to WIC in the month after they turned five years old. We knew that this rule was set up because most kids start school when they turn five, although it's not WHEN they turn five. Some previous work that I had done with my co-author Pourya on school foods, we knew that school foods really impact kids' diet quality in a positive way. We were interested in what happens to some of these kids that have this potentially long gap in their food assistance.

It's really fascinating to learn that there was a lot of research in this space on WIC oriented to mothers, and it sounds like what you're saying, little or not as much was focused on children. I'm interested to understand why do you think that's the case given the orientation of this program?

That's a great question. I think there's probably two ways to look at this. I think the most important is that most people would consider pregnant women and infancy the most vulnerable times of your life, and so understanding how the program impacts the most vulnerable would be of first order importance. Also, some of the early work that came out in the 1980s when people started really looking into the efficacy of WIC, focused on birth weights, for example, and you see that WIC's impact on low birth weights far outweighs the cost of WIC itself. For example, we're talking about women that live in low-income households, so in most cases, when these women go to give birth they most likely might be on Medicaid. Any outcome that would be a negative outcome or an adverse outcome at birth would be paid for through Medicaid. That was the first place that people looked, and that's when researchers realized very quickly that WIC is paying for itself just on the women participants and the child participants together at birth. There is definitely other research on children, it's just not as much research.

That's great. Let's go ahead and dig into the paper that was recently published in the American Journal for Agricultural Economics. What's the upshot? What did you find?

The upshot is that it seems like that WIC does work in terms of providing nutritious foods to the child participants. These are kids that are two, three, and four years old. One reason that that's important is that we know as kids age, the probability that they stay on WIC, even when they're eligible, declines dramatically. For example, at birth, as I mentioned earlier, I think the take-up rate is over 95%. That is because postpartum, immediately after birth, medical providers will give a screener at the hospital and if they see that Moms are eligible for WIC, they'll ask if you want to sign up. Part of the WIC package is to get free infant formula if the mother doesn't want to breastfeed or she's partially breastfeeding. So, you see a large uptake at that point. But then after the kid turns one and the package switches to milk and cereal and fruits and vegetables, that's where we start to see parents and caregivers not re-certify the children. Over time, by the time you get to four-year-olds, you're looking at, out of all the four-year-olds that are eligible, depends on what study you look at, but it's definitely under 50% participation, probably in the 30 to 40% range that are taking part in the program. For those that are participating, we're looking at what is being reported by the parents that the kids are actually eating. What we're finding is that foods provided through WIC, which are healthy foods, do impact foods that the kids are consuming.

This raises an important question about what you did in the study. This idea of how you describe food as nutritional or healthy - could you tell us a little bit more about how you measured diet quality? I know that there's also an interest in the quantity, so please explain.

That's right. We use this measure called the Healthy Eating Index developed by nutritionists. It gives you a score from between zero and 100, just like you'd have a test in school. The way it works is there are 13 different components, for example, one would be fruits. As you get closer to eating the recommended fruit consumption for that age group, you can score more and more points. There are other food groups such as vegetables and whole grains, etc. There are even some components that are nutrients, like saturated fats and added sugars. As you get closer and closer to the recommendations on all these different components, you get closer and closer to scoring a 100. We use this algorithm based off what the parents are reporting that the kids are eating. Then we're able to score how well they eat on this range from zero to 100. Now, I'll tell you, the scores that they're getting aren't that great, right? It's around 50 out of 100, so there's already room in improvement. This is not just for kids that are on WIC, this is in general, across all ages. Americans have a lot of room to improve their diet, and so that is our main outcome in terms of the quality. But we did also look at the quantity or the overall calories that the kids were consuming as well.

So, what you found was those kids, when they aged out of WIC, before they actually entered into school, they had lower quality diets? Was the same true with the quantity? I mean, in terms of the number of calories, could you tell us a little bit about that?

That's right. When we first looked at the sample in total, we didn't really find much of an effect of aging out of WIC program. But we were concerned whether the kids are in school or not. So, where we find the reduction in diet quality is for the kids that are born in, say the winter, late fall period. These are called late school starters. These are kids that generally are born after the cutoff date to go to kindergarten. So, for example, if a kid was born in September, they would miss the kindergarten cutoff. For most states, that would be August. So, they would lose WIC in October, and then they must wait all the way until the next school year before they would go on to most likely free school meals. We were able to split the sample into these late school starters, and then you have the other kids that are born, for example, maybe in the summer, so they would lose WIC but then could seamlessly slide into school food programs. For those kids that lose WIC and then go into the school programs, or maybe they even lose WIC while they're in school, depending on the state, we see no effects at all on the quality of their diet or the quantity of their diet. But for the kids that are these late school starters, the ones that are born in the winter or late fall, that's where we see this decline of on average of 20% decline in the quality of the food that they're consuming. But we still, for them, for those kids, we still find absolutely no effect on the quantity. What we're seeing is that parents or caregivers lose access to these nutritious foods that are being provided for free through the WIC program. But they're still feeding their kids the same number of calories. They are just switching to lower quality foods.

Is that finding true for everyone? Or are there differences in the individuals that you looked at in this study?

You can kind of imagine that if you were able to rank kids in households based on who's consuming the lowest quality diet, they would be on the very lower end of this HEI score versus kids that typically consume a much higher quality diet. They would be up higher at the end of this spectrum. This could be for a whole host of unknown reasons, right? It could just be the kids' own food preference, the household that they live in, and the parents' preference. It could be the food environment. But regardless of whatever those reasons are, what we found was that the kids that typically consume high quality diets at home, so they're on the upper end, we see really no effects for them when aging out of WIC. Where all the action is, where all the deficits and the diet quality come from are at the lower end. So, these are the most vulnerable kids that live potentially in areas with inadequate access to healthy food or whatever it may be, they're the ones that are taking the largest hit, and arguably, they're the most vulnerable.

This difference across households or across children is really important to recognize and it's an important place for interventions as we think about what the implication of your work suggests. So that's one of the questions I'm interested in understanding. What, if any, are the long-term effects of children aging out of WIC? It seems like there's a special period that this is happening. Do you think there are effects beyond that window of time before they start school?

I think that there probably are. Now, we couldn’t address that specifically in our study because of the way our study was designed. The effects that we're looking at are just for this transition when they're around the period that they're losing access around five. One reason just intuitively to kind of understand is why we can't extrapolate this out is that. As we add months past five years old, the probability that that kid is going to go into school is going to be increasing. So, you're going to start muddling the positive effects of school food programs. But to speak to these long-term effects, there's this whole long literature from nutritionists, and your listeners will probably just know this anecdotally, if you have small children or had kids or been around kids, is that it's really hard to get them to eat healthy, right? Or to try new foods. The WIC program is providing this opportunity to have access to these healthy foods, and the problem is that, I think, many people would also realize, or again, anecdotally, you would kind of realize that it's really easy for kids to have a reversion, right? You've been trying really hard, you're getting them to eat that broccoli, but then if all of a sudden you lose access to broccoli, and they say, oh, I can eat the French fries. It's really easy to go back to just eating those French fries and you take all this kind of nutrition capital, so to speak, that's been developed over these years of being on the WIC program, could quickly be wiped out. So that is a very important period. That's what the nutrition literature says. We haven't looked at these longer-term effects yet.

Well, thank you for that. Travis, it's interesting to find this idea that the calories don't change. So, if you will, the quantity doesn't change, but the mix, the nutritional value of the foods that children are eating changes if they age out of WIC. So, the question is, what challenges do you think parents are facing to continue to buy the WIC items or to buy these more nutritious foods during this age out period?

Yes, that's right. WIC is acting as a small income transfer, and so when you lose WIC, parents must then use their own money to buy food. By and large, whole grain bread, for example, will be more expensive than refined grains. Processed fruits and vegetables that may be canned that come with added syrups or fats will be cheaper than fresh produce. All these things add up when the parents are still feeding their kids the same amount of food and they're making these small substitutions for the lower quality foods. You do see that add up. I will point out that in terms of the calories, there was also another paper that came out right after our paper by Marian Bitler that showed that they were able to look at what was going on in the households. What they find is that the moms actually do reduce their own calories, which is a finding that we've seen in the context of WIC and other programs, and also, I think it seems, I guess obvious, is that the parents would be more likely to take the hit and shield their kids. Your paper doesn't speak to that, but there are these other implications for others in the household.

Wow, this is really important work. Thank you for sharing that. I'm interested in the policy shifts that could happen. How could policy change affect this issue, this problem, and the negative effects of aging out? What kind of policy tweaks are possible, and do you have a sense of the cost of that?

The obvious policy fix is to change the arbitrary rule of kids lose WIC in the month after they turn five years old, and just say, "Hey, you can stay on WIC until you get into kindergarten." We were curious about how much that would cost. We know from administrative cost data from the USDA how much it costs on average per month for a four year old to be on WIC, and so we just extrapolated that number out, assuming that births are random across the year, so that would mean you would have 1/12th of the population that would have to stay on WIC for 11 more months and then you have another 1/12th that would stay on for 10 months, and so on and so forth. We calculated the total cost of that under the current rules, and it came out to about a hundred million dollars, which sounds large, right? A hundred million dollars. But you must put that into context of the current spending. WIC currently costs about 5.7 billion, with a b, so that change comes out to about a 2% increase in the program to allow kids to stay on WIC until they turn five years old. Not only is that a small percentage of the WIC program, but that’s also less than a drop in the bucket in terms of food assistance spending. Again, to have a better context, the SNAP program costs, last year, I think it was about $120 billion, so it's actually a very small amount to allow kids to stay on the program. 

Is there any political movement or any movement in the legislature to address this problem?

Somewhat. There's been a bill called the WIC Act, which would allow states to seek a waiver from the federal government to do just that: to allow kids to stay on WIC until they get into kindergarten, or they turn six, whichever comes first. This has been proposed, I think at least since 2015, over and over. It's bipartisan that has sponsors on both sides of the aisle, and it's been proposed in the House and the Senate and in both also bipartisan support. But it's never gotten out of committee, which means they sent it to committee, doesn't get marked up, and it's never left. I don't know if this year will be any different. There's been several other bills that pertained to WIC that have also been proposed. I think there's more interest in revamping WIC. Whether this will happen with this particular one, I'm not sure, because as you may know right now, Congress is asking for more money to pay for WIC because it is discretionary, it's not mandatory. So, who knows, right? But there is this proposal to allow this to happen.

Bio

Travis Smith is an associate professor at the University of Georgia, Department of Agricultural and Applied Economics. His research interests focus on the economics of food, health, and nutrition, with a focus on food assistance programs.

Join Kelly Brownell in a conversation with Michael Dimock, Executive Director of Roots of Change, about transforming food systems through innovative policies. Discover how Roots of Change collaborates with various stakeholders to create nutrition incentive programs and support sustainable agriculture, focusing on community-first approaches. Learn about pioneering projects, insights into policy influence, and the future of agricultural practices. This episode provides an optimistic view of the evolving food system landscape and the potential for significant positive change.

Interview Summary

Why don't we begin by you explaining what Roots of Change does. What's the mission and role of the organization?

Yes. We were originally founded by a group of philanthropic foundations that were very interested in food system change but had not seen much success in years. So we were really designed to be a catalyst to ignite the growth of what we would call the Good Food Movement. For 10 years, we were actually a philanthropic fund investing in different projects that built the power of the food movement. And then implemented projects that would catalyze change. That would show how you could scale change fairly rapidly by building collaboration. So that's really what we've been doing. And in 2013, the philanthropic fund ended, we'd spent down all the money. So we joined the Public Health Institute at that time because public health is such an incredibly important engine for food system change because the food system impacts public health so greatly. We've been since that time focused on policy change and implementing model demonstration projects.

Thanks for that explanation. You talked about catalyzing change for transforming the food system. What sort of changes have you emphasized?

We've been focused on a few key things. I would say that one of the most important for us has been healthy food access. And doing that through the creation of nutrition incentive programs. And the reason we're interested in that is, all the changes that we pursue are aimed to hit several different levers of change simultaneously. By building nutrition incentive programs, you help the small and midsize farmers who are supplying local grocery stores, the farmers markets, and at the same time, you're creating the funding for low-income families to actually purchase organic, regenerative, sustainable agriculture. From their local market. You get a lot of payoff for that kind of action.

You mentioned incentives. How do incentives fit into this?

There is a program, a federal program called the GUSNIP. Named after Gus Schumacher, who was Undersecretary at USDA during the Clinton years, and actually worked with us early on. And so that program is a pool of funding through the Farm Bill that is given as grants to either states or nonprofits that are creating these programs where a family comes in with their SNAP benefits, and their purchasing power is doubled. They're given matching dollars to buy fruits and vegetables from a farmer's market, a local store, grocery store. So it's an incentive to purchase fresh nutritious food. And so, we have worked on the original federal policy. We're one of the first demonstration projects to show how you do nutrition incentives working with folks in the upper Midwest and in the East. And then we created an analog. California also has a matching fund which helps us pull more money from the federal level. So, we can really get a big impact at the local level. And we built that California program as well. We've been really deep in nutrition incentives.

But we also work on farmer farmworker protections from heat. It's a big problem out here in the West. Increasing temperatures. We're working with different scientists, epidemiologists, and farmers to figure out best management practices or technologies that keep farmers cool. And then we also work on programs to provide incentives for ranchers to produce regenerative meat, that is grass-finished meat.

So, those are the three areas working in right now. But we're also just starting a project. I have a meeting today with the California Department of Food and Agriculture to develop a plan for mid and small-scale infrastructure for regional food systems in the state of California to be achieved by 2040.

One thing I really like about your approach is the lining up of incentives to produce food in a way that's better for both human health and the environment. Because so many incentives are lined up the other way. Obviously, the food industry wants to make as much money as they can, and that comes from highly processed foods that aren't very good for health. And then the same sort of incentives lines up for agriculture to do industrial forms of agriculture where you maximize the yield per acre. To turn that around is really going to be a major effort. One thing I like about your approach is that you're trying different things that can become models for what could be used in a very broad scale in terms of public policy. I really admire that and like what you're doing. Do you have an overall strategy for helping bring about change?

One of the things that we did in 2010-11 is we did a deep analysis of the food system and did a systems dynamic map of the entire food system. Working with leaders, Secretary of Agriculture for California, farmers - big size, small size, organic, conventional, with food justice folks. And we looked at where are the real intervention points. One of the things that we really realize is that, as you were pointing out, the current incentives are for industrialization, basically. And so, the question is, how do you actually change that? And policy is one important lever for doing that. So, we work a lot on trying to change the policy levers to create incentives for what we would call healthy and resilient agriculture.

Tell me more about how you go about doing that. I'd love to hear when you're done with that, how you go about doing that with policymakers.

Well, I'll jump right in on that. Let's look at what we did with nutrition incentives. So, working with Fair Food Network out of the upper Midwest, and Wholesome Wave out East, Roots of Change did a study. We created our own nutrition incentive programs using philanthropic dollars and some USDA kind of innovative dollars, and then we studied it for two years, what the impacts were. We wrote a report then, which went to Congress, to Debbie Stabenow in Minnesota, who was the Senator there who was on the ag committee. And she began writing a bill that would say, okay, let's provide incentives for people to buy healthy food that also helped the small farmers. So that switched the incentive from the big agricultural systems to the regional food system players. That was one way we did it.

The other thing that we did in California was we organized all the farmers markets to go to the State of California and say, look, if you provide this nutrition incentive program in California and analog, we'll pull down more dollars from the federal government. The California legislature said that's a great idea. They got on board. Which then helped the farmers markets to provide more funding because farmers markets are often stressed. Too many markets, so there's problems. Competition between markets. So, to provide a new market, which is low-income families who are using nutrition incentives and their SNAP dollars, that was really important for the farmer's market. Those farmer's markets became another big piece of our strategy. Our way of making change was just to build collaborations, large collaborations of people.

We work with many other nonprofits and farming groups in California to approach the legislature and over the last three years we've gotten $1.3 billion dollars in investments from the state of California into sustainable agriculture and food justice. Because we're able to build these large collaborations who convince the legislators who really care about votes that there's enough people out there want to see this happen. And we have just placed a billion-dollar request on the next bond, which will be in the next election, November. This November there's the climate bond. It's called a climate bond for the State of California. Ten billion dollars, one billion of that will be dedicated to nutrition, nutritional health, farm workers, and sustainable agriculture.

So, in all ways, it's about getting enough voices. So, if you look at what we're really trying to do, we're trying to build the power of what we would call the Good Food Movement.

Best of luck with that billion-dollar request. I really hope that goes through. You know, in the beginning of your response to my last question, you talked about a report that you did in concert with other organizations around the country and how that became influential in the policy process. Very often, some of the people in my orbit, scientists, wonder how they can help with this kind of thing and how they can do work that makes a difference. And I've often thought that speaking with people in the policy and advocacy world, like you, turns up some really interesting questions they could help address, if they knew what those questions were. But they often aren't having those conversations because they're mainly speaking to other scientists. That's one of the reasons why I so much like having people who approach things like you do on this podcast series. Scientists aren't our only listeners, but they're among them, and it's nice to give them ideas about how they can connect their work with what's going on out there on the ground in terms of policymaking. So, you emphasize putting people in communities first. What does that mean? And how does that play out in the work you do?

It's a great segue from what you were just saying about the need to combine community voices with nonprofits and scientists, academics, and people who are good at research and who are good at analysis. Back to this idea of nutrition incentives that really grew out of what community groups were doing. The IRC (the International Rescue Committee) works with immigrants from Africa, primarily at that time who were coming into San Diego. And they were farmers, mostly. They were escaping violence, war, in their countries. And they came to San Diego and the IRC worked with them to create a farmer's market, and a farm - a community farm. And those folks were the ones that were saying, this program works. And this is a really good way to solve many problems at once. So, we were hearing from community members and the nonprofit that had created this model. So, it was a way of us understanding what was actually working on the ground. So that's one example.

I can also say that in 2017, 2019 and 2020, we had terrible fires here in California. We also had all that followed with COVID in 2020. We were working with the University of California at Davis. Tom Tomich, who at that time was with the Ag Sustainability Institute at UC Davis. And we were doing research on how do you deal with climate change as small farmers? And what we realized is there was this moment in time when all of these things that have been piling up were impacting the ability to get meat. You'll remember that meat disappeared from shelves for a while because all the big plants that process meat in the Midwest were shut down due to COVID. So, what we did is then went out and we interviewed ranchers up and down the State of California, and we asked them, what do you need? And are you interested in finishing animals for grass-fed markets? Are you interested in building local markets? We got a lot of feedback that led to a white paper that Roots of Change published with the University of California at Davis and put out to the world. Which led to us getting a grant to actually take some of the suggestions and the recommendations we had gotten from the producers about what to do. What's that led to now? We have built a relationship with the University of California: ten campuses, five medical systems. They have committed to buy regenerative regional meat from the State of California. That grew out of a white paper, which was fed information by the ranchers on the ground, analyzed by academics and nonprofits, and delivered in a system that's now gotten the university to make a commitment. So, it's another example of just how you can mix all these great parties to get some sustainable change at a large scale?

Now that leads me pretty nicely to what my next question. And it has to do with what's needed going forward and how do these things occur in more places in a bigger way than the places they are now. Now you mentioned, for example, the regenerative agriculture pledge that got made by the University of California system. That's a big enterprise. There are a lot of people that get touched by that system. So, that's a pretty impressive example of taking an idea that might've been smaller to begin with and then became bigger. Going forward, what kind of things are going to be needed to make that kind of thing happen more often?

That's a really good question. Kelly, I think that one of it is communication. I mean, perhaps some somebody will hear this and reach out to us and say, how'd you do that? And then we'll say, well…and they'll tell us what they did and we'll learn from them. One of the things I'm really interested in, always been interested in, and one of the things that Roots of Change is focused on is trying to convene people to share information. Because you build partnerships when you share information. And those partnerships can become the engines for getting the policy makers or the corporations to change their modalities. How they're doing things. Because they realize, hey, the writing is on the wall. This has to happen. We need to figure out how to get there. And sometimes it's complex to get there because the food system is very complex.

So, I would say that one of the things I'm really looking forward to is more cross collaboration. You know, we're living in the season of elections. We're hearing it on the news all the time. And the thing that drives the policy makers is whether or not they're going to be elected or reelected. And so, the more that we can convince them that there is a large majority of the public that wants to see these fundamental changes in the food system. We will have their support. We've seen it in California. We are getting incredible support from our Secretary of Agriculture, our governor, and our Secretary of Natural Resources. They work together to create things on the ground. I would say that the Tom Vilsack and Biden did a lot for regenerative agriculture, working on two big projects that have been funded by the USDA that will touch a thousand ranchers of bison and beef to get them to learn about, adapt, adopt, and then build new markets for their products. So that's an important piece. The other is the marketplace and companies want to sell their products. So, the more that consumers become discerning and what they're purchasing, the better off we're going to be. So, we have a podcast like you do. And what we're trying to do is just educate people about the connections between what they're doing and what the farmers and ranchers out there who are trying to do good work with the land and with health and with their workers. We just try to promote this idea of making good decisions about what they purchase.

Tell us a little bit more about your podcast, which is called Flipping the Table. Tell us more about what you're trying to accomplish and the kind of people that you speak with.

Well, it's similar to yours in a certain way, I would say. Because what I'm doing is interviewing the people that are doing the kinds of projects that we think are scaling change or could scale change. Or people who have a depth of understanding. So, the regenerative meat world, we've done a lot in the last few years. Talking to Nicolette Hahn Nyman, who wrote a couple of books about the meat system, with a great rancher up in Northern California, who advises other ranchers on how to finish their animals on grass in California in a dry environment. I just, today we dropped a podcast with Cole Mannix from the Old Salt Co op in Montana about the ranchers he's pulled together. The co op he's built that has a slaughter plant, restaurants, a meat shop, and has an online thing. And then they do a big, they do a big annual event in the summer during the solstice. So, you know, we're just trying to get voices who, like you are, who are, who are modeling and educating the public around what is happening. How much is actually happening. I've been in this world for 30 years almost, and I have to say, I have never been more optimistic about the scale of change, the accelerating speed of change, and the possibilities that lay ahead.

BIO

 Michael Dimock is an organizer and thought leader on food and farming systems and heads Roots of Change (ROC) a project of the Public Health Institute. ROC develops and campaigns for smart, incentive-based food and farm policies that position agriculture and food enterprises as solutions to critical challenges of the 21st century. Since 2006, Michael has been spawning and leading education and policy campaigns, community dialogues and creative engagements with government and corporate leaders to advance regenerative food and farm policies and practices that make agriculture and food enterprises solutions to critical public health challenges of the 21st century. His leadership has helped create one new law and funding program at the federal level and three new California laws that included two new funding programs and five successful budget requests. He began his career in 1989 as a sales executive in Europe for agribusiness and in 1992 founded Ag Innovations Network to provide strategic planning for companies and governments seeking healthier food and agriculture. In 1996, he founded Slow Food Russian River and, from 2002 to 2007, he was Chairman of Slow Food USA and a member of Slow Food International’s board of directors. Michael’s love for agriculture and food systems grew from experiences on a 13,000-acre cattle ranch in Santa Clara County in his youth and a development project with Himalayan subsistence farmers in Nepal in 1979. He is the host of the podcast Flipping the Table featuring honest conversations about food, farms and the future. 

Our guest today is Dr. Caree Cotwright, director of Nutrition Security and Health Equity at the Food and Nutrition Service at the US Department of Agriculture. Dr. Cotwright is leading a USDA-wide approach to advancing food and nutrition security in the United States. Part of her responsibility includes the charge from Secretary of Agriculture Tom Vilsack to make MyPlate a household name. MyPlate is the official visual reminder of the US government to make healthy food choices from each of the five food groups. Now, this turns out to be a tall but important order. About a quarter of US adults have heard of MyPlate, according to a recent survey.

Interview Summary

You came to USDA while on leave from the University of Georgia (UGA) where, by the way, you were the first Black woman in the Department of Nutritional Sciences to earn tenure. Congratulations for this, and please know how much I appreciate the important role that you've played in our field. So, let's start with discussing what drew you to food policy and what makes you excited about your role in public service at USDA?

I am really excited about this role because it's just a privilege. When I think about the fact that USDA has the title or has a position for the director of Nutrition Security and Health Equity, I get excited about that. It's been a privilege to work on advancing all of the things that have come about because of the White House Conference. I came to nutrition policy really in a kind of a roundabout way. I was working on my master's at UGA and I was doing an internship at the Center for Science and the Public Interest (CSPI). At that time, I was wanting to write on the Nutrition Action Health letter, but they had someone who was mentoring in nutrition policy and that someone was Margo Wootan. She kind of took me under her wing and helped me to learn about what nutrition policy was. 

After completing my master's and my PhD, I did my postdoc, and then did a RISE fellowship at the CDC. I was working on disseminating policy around early care and education obesity prevention policies and just really to understand the keen role that policy plays in the advancement of nutrition and policies in general. That was really eye-opening for me. I knew that during my role at University of Georgia as a faculty member that I would focus on both policy and intervention. I've had such a wonderful experience of being able to use different creative approaches, but also using policy. Some of those approaches have earned me the opportunity to talk to a variety of communities in different ways, including having a TED Talk. It's just been a joy to do this work.

You've had so many interesting experiences and I could see how you'd be passionate about food policy after spending time at CSPI, especially with Margo Wootan. There aren't many people that know food policy like she does. But one thing I wanted to ask you about is one of the highly novel part of your work and your approach to nutrition has been to incorporate the creative arts, including storytelling. Tell us about this if you would.

Storytelling has always been near and dear to my heart. When people ask me about that question, I've been doing it since I was about five years old when I was asked to come and give the commencement speech for my nursery school. I wasn't afraid, it was fun for me, and I just said, "Wow, this is really something that I can do." I enjoyed connecting and engaging with others. As I think about my work, I know that telling stories and using creative approaches to meet people where they are helps us to promote a variety of topics. Of course, it's kind of entertainment education, but using these approaches is a catalyst to get people interested in what we're doing. We know we're competing with so many things that pull people's attention now. 

Some of the things that I've done are I have a play about nutrition for young children, I have a hip hop song. I tell stories even in my speeches because I know that when I can connect, people will remember that story. And that's so important. Through my work, I promoted the Child and Adult Care Food program. I worked on the SNAP-Ed program at University of Georgia. We've done creative things like having skits and have enough care to call Healthy Bear that the children relate to. Even in some of our work that I've been blessed to have and had the privilege to work with Robert Wood Johnson Healthy Research to have social media and to use all of these approaches, but to use it to promote health and use it to promote healthy messages and messages specifically about nutrition. That creativity and those approaches are things that I bring to my current position in thinking about how do we engage the public, especially as we continue forward with advancing nutrition security and health equity, as well as making MyPlate a household brand?

I love that creativity. I think back on memorable speeches I've heard or talks I've listened to and things, very often, it's the stories that you remember. The fact that you're recognizing that, appreciating that, and perfecting it, I think is really impressive. I'm glad to learn a little bit more about that. Let's talk now about your federal service at the CDC. This was another experience that I know helped shape your interest and your passions and your desire to return to public service at USDA.

That's a wonderful question. It was such a wonderful opportunity to come to CDC at a time we were on the cusp of really thinking about how do we develop and disseminate policy related to obesity prevention for our youngest children, age zero to five. I had just finished a postdoc in community-based participatory research at Morgan State University working with Head Start children. At the time when I got to CDC, we had former First Lady Michelle Obama working on Let's Move! One of the key initiatives was Let's Move! Child Care. We modeled the initiative and the work we were doing related to policy on the work of an outstanding researcher. Her name is Dr. Dianne Ward. Not only was she an outstanding researcher, she became a mentor, colleague, and friend of mine. I just have so much admiration for the work that Dianne Ward did and the trailblazing efforts that she did to advance policy in the early care and education setting related to obesity prevention, but also in equity. 

So we were working on these things and my task was to go around to stakeholders all across the country and make sure that they understood what we were saying. So again, bringing in that community engagement and the training that I had, I said, "We can't just put this on a website and say, 'Hey everybody, you should go out and do this.' We have to go in and teach people and train people and explain it." Fortunately, my mentor there, Dr. Reynolds and Heidi Blanck, they agreed. I was able to go out and help to disseminate the policy, and again, it gave me such a strong and firm understanding of how to really relate. 

I'll tell you just a quick story. At the time, I didn't have kids, Kelly, and we were talking about these obesity prevention policies and we said, "Okay, no screen time for children under two," and those things. It wasn't until I had kids and I thought, "Well, how do you do that?" Because it has to be realistic and you have to think about how these policies work on the ground. As I talk to childcare providers, as I talk to stakeholders, as I talk to people working at the state level across the country, we help gain an understanding for just how these policies will go into place and gain support for policy implementation because we can't do the work without the people who are working on the ground level.

Two things I want to make note of that you just said. First is if it's easy to to talk about how children should be fed and learn about food until you have them, and then all of a sudden, it gets a lot more complicated, I know. But the other thing I'm grateful that you did was to pay tribute to Dianne Ward. Many of our listeners may know she was a professor at the University of North Carolina at Chapel Hill and recently passed away. There are people all over the country in the world who were just broken hearted by this because she was such a dear friend and colleague to many of us, and just a completely inspired researcher who wanted to make a difference in the world and really did. It's not surprising that she touched you and your professional career in such positive ways and that's true of a lot of us. I'm really happy that we were able to talk about her for a moment. So thank you.

Thank you. Thank you for allowing me the opportunity.

Let's talk more about your current position at USDA now. Can you tell us what your primary responsibilities are and what your vision is for your work ahead?

Yes. My primary responsibilities are to advance the work of food and nutrition security and health equity. I know that's a part of my title, but we really are working to make sure that people are able to get access to the food they need. Our definition is that nutrition security means that everyone has equitable access and consistent access to healthy, safe, and affordable food that is optimal for their wellbeing. We do this at USDA through four pillars. We think about having meaningful support for nutrition and nutrition education, making sure that people have access to that healthy, safe, and affordable food, making sure that we work through collaborative action through partnerships, and then making sure that we prioritize equity every step of the way. 

When you think about USDA and the programs that FNS has and the programs that we are working on in our mission area, we have lots of opportunities to advance nutrition security because our work is just so closely related. I work very closely with our programs and I work a lot with our stakeholders, both internally and externally, to make sure that people are aware of the work that we're doing. But not only that, that we are leveraging things like the historic White House Conference, making sure that we have lots of commitments from people all over. We've had over $8 billion of commitments. But making sure that with our stakeholders and our partners, that we lean into new creative approaches that will help us to reach our goals. We have some really big goals to end hunger, to improve nutrition, physical activity, and to reduce diet-related diseases and disparities. We are holding ourselves accountable and making sure that we're getting the word out and making sure that we're partnering in very meaningful ways. 

A part of my larger vision is a part of the secretary's vision, which is to make MyPlate a household brand. We think about what does that mean? We want to make sure, you said early on that about 25% of Americans are aware of this tool, but we want to make sure that not only are they aware, but they use the wonderful resources that are attached to MyPlate because it is our federal symbol for healthy eating.

It's heartening to hear about your vision and to understand the kind of progress that's being made to advance food and nutrition security, and also to specifically leverage some of the commitments that were made at the White House Conference. In addition to what the federal government can do, are there things that individuals can do like our listeners, for example, or the ways they can help?

Yes, and I'm so glad you brought up your listeners because that's so important. So every voice matters. And so all of our actions add up collectively. I've heard up from some wonderful, wonderful people in West Virginia and Oklahoma, just all across the country. When I go out and speak and I tell people, "You have to help me with this mission of making MyPlate of household brand." They sent me back things that they're doing. Creative things like setting up kids farmers' markets, popup markets in places like hardware stores that don't traditionally do that. But they will set it up and let a farmer come in and set up a popup shop, and then they provide the tokens through some of our wonderful programs like SNAP-Ed and FNA. When we think about these creative solutions where there are already existing things, but we're solving a problem, we're solving that access problem. Just thinking about that and making sure that we are all collectively working together, we want to hear from you. We want to hear from you. I always give out my email. It's caree.cartwright@usda.gov. We want to hear from your ideas. We also have our pillar pages on our website. If you just look at nutrition security at USDA, we have our pillar pages so you can learn more. But we also have a very short video where we're talking about the work that we're doing and highlighting that work, and a blog that is attached to that. So again, if you're wanting to promote efforts that we're doing, that's a very quick synopsis and a short way to get it out there to people to spread the word and increase awareness about all of the wonderful things that we're doing to advance food and nutrition security.

I never thought of my hardware store as a place to learn about nutrition, but why the heck not? Let's talk about MyPlate a little bit more. What's your role and how are you going to go about trying to make MyPlate a household name?

It's a very multi-pronged approach. My role is to bring those creative approaches. One of the things I love about this position is that it's a culmination of so many of the things that I've already been doing. Using my creativity, thinking about the equity focus, and working with our Center for Nutrition Policy and Promotion. They're a wonderful team. They've already been doing wonderful things on MyPlate but helping to amplify that work and helping to get it out there so we make it a household brand. We have a multi-pronged approach where we'll be using social media. I told you I was able to use that in my research. Not only that but doing things where we're celebrating the great work that people are doing around MyPlate. Like for example, I know in Oklahoma, they had a wonderful day at the capitol and the lieutenant governor was working with students to put food in the right MyPlate categories and making sure that people are aware of them. There are artists making songs about MyPlate. And so, making sure that we are making the public aware of what we're doing. With this multi-pronged approach, we'll be doing listening sessions. We're hearing from people about what can we do better? What do you really like? Are here things that we can change? Really hearing from the community on that level. Then, also thinking about industry and how can industry partner to promote MyPlate and promote those food categories so that people have an understanding of MyPlate and the branding of the icon. Making sure that people recognize MyPlate and the icon and are knowledgeable about the resources that we have. I'm really excited about doing partnerships because this is a one USDA approach. We're going across all levels to make sure that we get the word out about MyPlate. And we do have a MyPlate national strategic partnership with partner organizations all over the country that are already helping us to do this work. We want to attract new partners, to have new partners to come in, and lean in to help us to amplify MyPlate and all the wonderful resources for the public.

I'm assuming it's pretty easy to find out about MyPlate online, is that right?

It is. It's myplate.gov. It is very simple. All of our materials are branded with that, but it's very simple. You can remember MyPlate, you can remember our website. So it's myplate.gov. You can go directly there and find all of our wonderful resources, and we'll be having more, as I said, on social media. I don't want to forget this point too as well, Kelly. There are cultural adaptations. When I'm out in the field, people ask me about, what about for my culture? What about for the things that I eat? How is MyPlate relevant to that? What I love about MyPlate is that it's so adaptable. During our listening sessions and the work that CNPP is doing, we are working to address that as well. Again, meeting people where they are, having them understand that your cultural foods are healthy foods too, and how do we use MyPlate to guide our healthy choices when we're making our meal choices. Again, you look at the plate, half the plate is fruits and vegetables and that can be from a variety of sources and a variety of cultures and preparations and lots of different foods. And so we want to make sure that people are understanding that and that we get the word out there.

Bio

Dr. Caree Jackson Cotwright serves as the Director of Nutrition Security and Heath Equity for the Food and Nutrition Service at the United States Department of Agriculture (USDA). In this role, Dr. Cotwright leads a whole-of-Department approach to advancing food and nutrition security. She also serves as one of two Departmental representatives on accelerating action on the White House Conference on Hunger, Nutrition, and Health goals to end hunger, improve nutrition and physical activity, and reduce diet-related diseases and disparities and implementing the corresponding National Strategy. Her work includes building public awareness of USDA’s actions to advance food and nutrition security, as well as collaborating and building partnerships with key stakeholders to maximize our reach and impact. Dr. Cotwright is on leave as an Associate Professor of Nutritional Sciences in the University of Georgia’s College of Family and Consumer Sciences’ Department of Nutritional Sciences. Her research centers on promoting healthy eating among infants through age five-years-old with a particular focus on accelerating health equity among historically underserved populations via community-based participatory research and focusing on developing, implementing, evaluating, and sustaining best practices and policies in the early child education setting. She has developed a variety of innovative interventions, which use theater, media, and other arts-based approaches. She is the author of numerous peer-reviewed publications and secured over $1M in grants focused on obesity prevention and health equity from Healthy Eating Research, a national program of the Robert Wood Johnson Foundation, and the USDA. From 2010-2013, she worked as an ORISE Research Fellow at the Centers for Disease Control and Prevention Division of Nutrition, Physical Activity, and Obesity, where she was highly engaged in the early care education elements of the First Lady Michelle Obama’s Let’s Move! initiative dedicated to helping kids and families lead healthier lives. Dr. Cotwright holds a PhD in Foods and Nutrition and Community Nutrition and MS in Foods and Nutrition both from the University of Georgia and a bachelor’s degree in Biology from Howard University and is a Registered Dietitian Nutritionist. She lives in Athens, GA with her loving husband and adorable three daughters.

In the United States, food insecurity is unevenly distributed. Recent data suggests that white households have nearly a third to one half the food insecurity rate of Black and Hispanic households. While research on the reasons for food insecurity typically focuses on income, a body of research suggests that wealth could be an important factor in food security. According to today's guest, Conner Bailey, professor emeritus of Rural Sociology at Auburn University: "Land is one of the major sources of wealth controlled by Black families in the South, and much of this land continues to be owned as heirs property." Thus, if we want to understand differential food and security, we need to consider that the wealth implications of heirs property.

Interview Summary

Connor, recently, the topic of heirs property has attracted much attention from researchers, policymakers, and civil society. Can you briefly describe the phenomenon of heirs property and why you think it's important?

I think of heirs property as, in a phrase, "the legacy of Jim Crow." By that, what I mean is that during the Jim Crow era, imagine say 1880, you're 15 years after the end of the Civil War, and you're a Black farmer, and you've bought some land, are you going to write a will to pass that property down to your heirs? Probably not, because your access to education is pretty limited. Moreover, there are no Black lawyers because where are the Black lawyers going to come from if there's no education for Black people, right? That's the Jim Crow era. So, what's your choice? You're not going to go to the white lawyers for the courthouse gang that you simply don't trust. The whole legal system is something that Black farmers, and Black people generally, fundamentally did not trust. This is the era of lynching after all, when people would be pulled from their homes, and in front of the law, nobody would be able to say who perpetrated these crimes. It was a difficult time for African-Americans, for Black people, for Black farmers generally. They wouldn't write wills because they didn't trust the legal system. What we end up with is that family that bought land in 1880, and they pass on, and the next generation, and the next generation, they're still not writing wills. We know that many people don't have wills. I don't know, Norbert, if you have a will. I don't need to know, but the fact is, many people, white and Black alike, and Hispanic and others, in this country don't have wills. But when they die, they're able to sort things out before it passes on to the next generation and becomes increasingly complex and confused and tangled. That's not true in the case of African-Americans and some other politically marginalized populations, white people in Appalachia, Hispanics, Native Americans, Hawaiians. heirs property is not just a Black phenomenon in the South, though that's where my research and most research on heirs property has been.

What we end up with in the case of the Black South, heirs property is something that is multi-generational. It's not simply dying without a will intestacy, but it's the dying without a will over multiple generations so that you end up with maybe 200 people who own a house or a piece of property, farm, or some forest land. How do you make decisions in a situation like that on maintaining a house, or improving the farmland, or planting trees, or whatever it is you're going to do with that property? How are you going to go to a bank and say, "I want a mortgage"? They're going to say, "Well, how do we know who's got the rights to sign on a mortgage?" As a result, there's no access to commercial credit. Until very recently, and we can come back to this later, Black farmers had no access to government credit programs through the US Department of Agriculture. They could not get credit loans. If you were in the Lower Ninth Ward of New Orleans and you were wiped out by hurricane Katrina, you had no access to FEMA support because you did not have clear title. Heirs property is a form legally called Tenancy in Common. That means you don't have clear title. Nobody has clear title. Everybody owns a share of the property as a whole. Now, one of the reasons it's important is it's not a small phenomenon.

Today, based on research that I've done with my colleague Ryan Thompson at Auburn University, there are in the 11 states of Appalachia and the South, 5.4 million acres of heirs property worth something like $43 billion. That's after enormous amounts of land have been lost through predatory actions. Legal but predatory partition sales, tax sales, and the like. Heirs property is a source of vulnerability. People have lost property in large areas. That whole stretch of coast of the South Atlantic, from Myrtle Beach down to Jacksonville, Florida, all that resort land, that was Black-owned land until after World War II. In the 1950s, once malaria was controlled in that area, bridges were built to the Sea Islands, developers followed, and properties were basically stolen through legal means, through something called a partition sale. Now you've got this enormous resorts being built there, much money being made, but these people who have lived there for generations have been dispossessed.

So, why is it important? It's for all these reasons, for these moral reasons, for the impact of the fact that you've still got millions of acres that's tied up in heirs property that people can't develop and utilize effectively for farming or forestry, or even for their own homes. It's one of the main reasons of wealth disparities, as you mentioned at the outset, Norbert. That the wealth disparities between white and Black are enormous. The St. Louis Fed just last month put out a study that showed that for every dollar of wealth that white Americans own, Black Americans own 24%. Black Americans own very much less wealth. Heirs property is one of the reasons. It's not the only reason, but it's one of the reasons, because lands have been stolen, lands have been lost, and those lands that still remain in heirs property, five-plus million acres just in the south of Appalachia, are underdeveloped, underutilized, and under-preserved.

Thank you for that. Connor, I want to ask you a question about trust. It's in the paper, and you mentioned it earlier, this idea of African-American, Black households, Black individuals not trusting the legal system. The reason I want to push on this is one could argue that trust could be because you may not know any better or you don't have enough information. We don't trust strangers because we just don't know what they could do. I'm wondering if another way of looking at this, something I've learned from people who do work on bioethics, Wylin Wilson here at Duke and others have talked about this, about the systems being untrustworthy. It's not that people aren't aware or can't navigate, but rather that the system or the institutions have proven not to do right by individuals. How does that characterization sit with the work that you've been doing?

Well, as I've been working on heirs property, as I have for 15, 16 years now, this phrase, "Black farmers, property owners generally did not trust the legal establishment, didn't trust lawyers, the courthouse gang," that's an easy statement to make. But as I started looking at the literature on heirs property, there wasn't a lot of background to that. I spent several months reading a bunch of older literature, W.E.B. DuBois, Arthur Raper, and others who were documenting what it meant to be Black in the rural south in the early decades of the 20th century. It's very clear to me that Black property owners and Black residents of that region as a whole had very good reasons not to trust the legal system. It was used against them in many cases. People simply avoided going to the courthouse whenever possible.

Now, this is an important point, and so thank you for exploring that with me. I've got to ask, I know you were at Auburn University and you're now retired. What led you to study heirs property and unearth its importance? Why are you still doing this work?

The second question is very easy to answer but also very important. There is a moral quality to the research that is done on heirs property. The work that I'm doing - and others, and I'm not the only one - the work that we are doing has a moral quality to it. We're trying to identify problems and redress wrongs. That's what gets me up in the morning. I mean, I'm seven, eight years, seven and a half years out from retirement. but I'm still publishing on this topic because it's important. Now, how did I come to realizing that? From a very good graduate student of mine named Janice Dyer, who was working in West Alabama on a different project, having nothing to do directly, we thought, at the time, on heirs property. The project was really on small scale wood harvesting and processing so that people could build homes using wood that's on the land that they owned. Janice came back after spending some time out in the field and said, "Hey, there's this thing, heirs property. People don't have clear title to their land." I said, "Oh, okay." I read a little bit about that, but she said, "No, no, this is a really important thing. Pay attention." Okay, Janice, I'm going to pay attention. And you know, here I am 16 years later. I'm still paying attention. One of the reasons professors get better at their jobs, and Norbert, you should appreciate this, is that we work with really bright students over time, and we gain so much from working with these students and undergraduates as well. So, I came to this because a graduate student pulled me into it and said, "Pay attention. This is important."

Thank you for that. I do agree there is something critical about engaging students to understand that topic. I want to actually take that a step further and because I know of some of the other work that you've done, how have you engaged communities in this work? Obviously, this is not an ivory tower kind of issue. This is something that affects the livelihoods of everyday people. How and in what ways are you engaging that community of folks?

I work with people in civil society organizations like the Center for Heirs Property Preservation in Charleston, South Carolina, created by a woman named Jenny Stephens back in the early, I think, 2004 or 2005, and other organizations that represent people who own heirs property. I've been working with people in the legal community through the Uniform Law Commission and all kinds of other groups. It's simply a matter of understanding that what we can do in the ivory tower is important because we can document the extent of heirs property, for example. That doesn't take working with communities, but we need to be working with people in communities affected by heirs property so that we understand the real significance of it and to keep the moral energies flowing. So, for example, my co-author on a couple of recent papers, Ryan Thomson at Auburn, he did his doctoral dissertation with the Gullah Geechee in South Carolina, which is near where Jenny Stephens in the Center for Heirs Property Preservation is located. Ryan worked actually far more closely with people who were heirs property owners and organized around that issue than I have done. But it's really important to understand from the people who are living the life of heirs property owners and who are facing the struggles to understand what are the issues so that as researchers, we can try to address those issues and try to come up with policy recommendations that might be helpful.

Thank you. One of your recent publications titled, "Heirs Property, Critical Race Theory, and Reparations," recently won the annual Rural Sociological Society's Best Paper of the Year award. First, congratulations, but secondly, can you explain your approach and your findings.

As I was saying earlier, I was looking at the question of trust, the trust of Black property owners and Black residents of the South to the legal system. As I was reading that literature, the idea of critical race theory simply emerged into my consciousness. I did not start off my reading saying, "Okay, I'm going to go look for evidence that's going to show critical race theory." Rather, it kind of emerged because critical race theory talks about the longstanding, deep institutional patterns of discrimination that are built into our legal system, our cultural system, our educational systems. They are so deeply ingrained that we often don't even recognize them, or we consciously, sometimes, ignore them. But there are discriminations built deeply into our systems sometimes that we don't recognize. What heirs property represents, as I said at the very outset, the legacy of Jim Crow. The legacy of Jim Crow is all these institutional limitations placed on Blacks in terms of access to education, legal services, and commercial loans, insurance for their properties, redlining in cities of where you could get government assistance or not. All these things are built in and are deeply embedded. Even though we have removed many of the outward mechanisms and trappings of racial discrimination, these patterns are still there. To speak of heirs property in terms of critical race theory simply made sense. It emerged the realization in my mind that this phenomenon of heirs property is rooted in these institutional relationships. It sort of hit me between the eyes with a two-by-four. It was like, wow, this is a perfect use of a theory to help explain a phenomenon. That's what academics, we should be pretty good at that, but that's what I've basically done. I don't think of myself as a theoretician, but the theories help us understand here are the key variables, the key phenomenon that we need to focus on if we're going to understand that particular phenomenon.

The question of reparations, which is the last term in that title, refers specifically to the Gullah Geechee, and I was talking about earlier, about that stretch of land. It's now billion dollar resorts. It's unrealistic to think that anybody's going to come and take that land away from Hilton and Sheraton, and all these major corporations, and give it back to the Gullah Geechee. That's just not realistic. But what if we charged a 1% lodging tax? There are already people coming and using those resorts who are already paying six and 7% on top of their bill for police and fire protection and things for the local counties and municipalities. What if we added 1% and gave that to the Gullah Geechee? There's a couple of entities, and I believe to others to make that decision. Who? But there's the Gullah Geechee Nation, and there's also a federally mandated Gullah Geechee Cultural Heritage Corridor. It's a 501 organization. Monies from that could be utilized to support the Gullah Geechee in clearing title for their remaining heirs property or for buying new properties to replace those that have been stolen, legally, but still stolen. So, to support the subsistence fishing and farming activities that have supported the Gullah Geechee for many, many generations, stating back to the post-Civil War era.

Thank you for that. This is going to really move us into this last question that's connecting this idea of, and I appreciate how you talked about how theory can help us as researchers do the work that we do, but then there are implications of that theory to actual policy and the lived experiences of folks. My question is, how has the research that you and others have done on heirs property affected policy at the local state or even federal levels?

As I said, there's a large number of researchers and others working on heirs property. I want to give a shout out to a couple of organizations that have been really critically important. The Southern Rural Development Center based at Mississippi State has become a really important convener of a lot of us working in this heirs property space. We have regular monthly Zoom calls. We have subcommittees on research, on policy, and on education and extension that meet regularly. There's a policy center at Alcorn State University that has become very important in helping organize and support research on heirs property. There's the Federal Reserve Bank of Atlanta that has also served as a convener and bringing people together. So, we've got individuals. We've also got some really important institutional actors that are providing continuity for those of us who are wanting to find a mechanism to interact, but they're providing that mechanism. There's a lot of people working on the question of heirs properties becoming increasingly visible not only in the research space but also among policy makers. For example, in the 2018 Farm Bill, there was wording introduced and passed in the 2018 Farm Bill, that allowed heirs property owners who were farming land to gain access to what's called a farm number through the Farm Service Agency. The farm number is critical, because if you have a farm number, you can now get a loan from USDA. Before that, heirs property owners could not. Basically, farmers operating heirs property now for the first time have access to credit through the USDA. That's a very important step forward. It actually came from a South Carolina Republican Senator Scott, and an Alabama Democrat Doug Jones, who worked up the wording on this, and it got later placed into the Farm Bill.

The other thing that's happened is that FEMA, I mentioned Katrina earlier, FEMA has revised their policies so that now, if you can prove you've lived in that home, you've lived on that property, you've paid property taxes, you've got maybe home insurance or whatever, if your property is damaged, destroyed in a natural disaster, a storm, FEMA will now help you. But 10 years ago, that was not the case. This happened only in the last couple of years. The point is, people have started to pay attention to heirs property. I've got to say people working in the media like Politico and The Atlantic and the New York Times, and The Washington Post, they've picked up on this. They've called researchers. They've called people like me and colleague Ryan, and they've gotten the facts from us, and they've developed it. They've gone and interviewed people, and they've developed the stories. And the media has also drawn a lot of attention to the issues associated with heirs property. It's been kind of a full-court press. We've all been moving forward on this.

Bio

Conner Bailey is an emeritus professor of the Department of Agricultural and Rural Sociology in the College of Agriculture at Auburn University. He holds a Ph.D. in development sociology from Cornell University. His research has focused on the problems of persistent poverty associated with resource dependence, the emergency of grassroots environmental movement surrounding issues of environmental and natural resource management, issues of environmental justice, and the human dimensions of fisheries and coastal resource systems. Bailey has been working on the issues of heirs property for more than 20 years. His publication "Heirs Property, Critical Race Theory, and Reparations," recently won the annual Rural Sociological Society's Best Paper of the Year award.

The Supplemental Nutrition Assistance Program is one of the largest poverty alleviation programs in the United States and provides help to around 14% of the US population. Since 1996, the program has required able-bodied adults without dependents to work in order to receive food assistance. Proponents of work requirements say it prevents government dependency. Critics, however, argue work requirements push out the people who need food assistance the most. Today we'll talk with two economists about the impact of SNAP work requirements: University of Rochester's Elena Prager. and Adam Leive at the University of California, Berkeley.

Interview Summary

You two were part of a research team that also included economists from MIT, Harvard, and the University of Maryland and recently published an analysis of the effects of SNAP work requirements in the American Economic Journal: Economic Policy. Adam, before we jump into the study, would you tell our listeners what SNAP work requirements are and how proponents and critics see them?

Adam -  Sure. So, SNAP's work requirements dictate that some recipients must be working, training, or volunteering to receive benefits for more than a few months. So the policy is historically applied to childless adults who are younger than 50 and don't have a disability, and as you mentioned, this group is often referred to as able-bodied adults without dependents and called by their acronym ABAWDs.

So, the work requirement stipulates that ABAWDs must be working 80 hours per month, participating in a qualifying training program or volunteering. If they don't satisfy that requirement, then they're only entitled to three months of SNAP benefits within a three-year period. Counties with high rates of unemployment may temporarily be granted exemptions from the policy by USDA's Food and Nutrition Services as well. So in terms of kind of the proponents and opponents of the policy, those in favor of work requirements are concerned that providing government benefits discourages work. These people generally believe that those recipients of government assistance should work as a condition for that help. Their argument for the policy is that by incentivizing work, people will develop a stronger attachment to the labor market. Eventually they become self-sufficient, and they can earn enough to get by without the government assistance.

By contrast, the critics see work requirements as a policy that prevents people who are economically vulnerable from receiving food assistance, and it prevents them from accessing assistance in times when they need it the most. So, the opponents argue that if the reason people are not working is something other than the economic incentives of the policy, then the work requirements are really just going to cut people's benefits without getting more people to work. It's worth noting that work requirements have long been contentious and most recently were the main issue in the debt ceiling debate. So as part of that compromise, the SNAP work requirements will gradually be applied to ABAWDs up to age 55, but additional groups will now be exempt from the requirement, including veterans, the homeless, and those who are 18 to 24 who were previously in foster care.

I really appreciate how you've brought in the changes to the rules around work requirements under the Inflation Reduction Act. This is going to be an important policy discussion as we move forward. It's interesting, particularly the exemption for individuals who are unhoused because of the work that shows up in the paper that you all have. So Elena, let's now turn to you. How did you study the effect of work requirements in this paper?

Elena - As you might imagine, studying the effect of work requirements on SNAP recipients and potential recipients is actually a little bit tricky. You have to be able to find comparable groups of people, some of whom face work requirements in SNAP and some of whom don't, but are otherwise similar enough to one another that it would make sense to compare their employment trajectories and their use of SNAP. Generally speaking, you don't just directly want to make that comparison across people to whom work requirements apply versus people to whom work requirements don't apply in SNAP because they're pretty different groups. The ones who face work requirements tend to be younger, tend to not have disabilities, and tend to not have dependents like children, especially, in the household. As you can imagine, if you look at the folks who are exempted from work requirements under typical SNAP rules, there are lots of reasons why they may be less likely to hold a job than the ones who do face work requirements. They may be older, or they may be disabled. So, you can't just attribute that difference to the work requirements themselves, which means in order to study the effect of the work requirements, you have to go looking for a context where the people who face them and don't face them are much more similar to one another than that.

What we ended up doing is looking at essentially the same set of people as work requirements policies changed over time. In fact, what you end up doing is comparing the same person before work requirements exist to the same person after work requirements exist. Now, you might say, "Okay, but work requirements have been part of SNAP for decades. Where did you find a time when they didn't exist?" The answer is that temporarily, many states suspended work requirements for a few years starting in the Great Recession when the job market was very weak and it was just considered too hard for people to find jobs even if they were trying. States were attempting not to be punitive during a very difficult job market. One of those states was Virginia, and so we got very detailed data on both SNAP use and employment and earnings from employment from the State of Virginia. Then we were able to trace what happened to SNAP recipients when that work requirements suspension expired in the fall of 2013. Virginia then put work requirements back into SNAP, which meant suddenly the same people who could use SNAP without work requirements just a month before were facing work requirements newly. We could compare how their employment responses changed to the changes of the employment responses of other groups who continued to be exempt from work requirements, for example, because they were just a little bit older than 50 when work requirements came back. We followed both of those age groups, comparing whether they were working and whether they were getting SNAP for several months and years after work requirements were reintroduced by the State of Virginia. That allowed us to both solve this problem that it's generally very hard to make comparisons across groups. In this way we were comparing sort of across groups but also within the same person.

In addition, the nice thing about designing the study this way is that we got to study not just those people who got on SNAP knowing that they would face work requirements and so thinking it was worth all the administrative hassle to get on SNAP in the first place because they expected to be able to meet the work requirements and continue to receive SNAP. But we were also able to study those people who knew at the time that they got on SNAP that they probably wouldn't be able to meet work requirements if those work requirements existed. But because work requirements were suspended at the time, that actually didn't discourage them from signing up in the first place because they knew that they were going to be able to stay on SNAP for a longer time while work requirements continued to be suspended.

Great, thank you. I realize this is a critical part of your study to be able to find the exact cohort and the fact that you were able to follow those individuals over a period of time compared to what some other studies have done, where they look at the sort of a sample of people that changes on an annual basis or that's more cross-sectional. I really appreciate the great care that you all put in to discerning who that sample should be, and that offers up really clean ways of understanding the effect of a ABAWD work requirements, so thank you for that. Adam, what did your research show about who's right about the effect of work requirements? Can you help us understand that debate a little bit more carefully given the findings of your results.

Adam - Let me begin by kind of summarizing our main results. So, we found no evidence that work requirements led more people to work. The same number of SNAP recipients worked whether work requirements were in effect or whether they were not, and the large size of the administrative data that we had access to allowed us to be very confident from a statistical perspective that any effect on employment that's positive is likely to be extremely small.

We also didn't find that earnings increased on average either. However, what we did see was a substantial drop in the number of ABAWDs enrolled in SNAP. We found that work requirements cut enrollment by more than half among ABAWDs, and this is a dramatic reduction in food assistance. This drop in SNAP enrollment was largely driven by people who were already on the program when the work requirements turned back on in 2013, as Elena was just describing, but we also found that many people who were newly enrolled exited the program sooner, and then some potential SNAP recipients did not enroll at all compared to what we would've expected in a world without work requirements. So, putting all of that evidence together, overall we found no evidence in support of the arguments that are made by those who favor work requirements.

Great, thank you. Elena, do work requirements have any other effects on potential SNAP recipients?

Elena - Well, Adam already covered the two primary study outcomes that we looked at and that policymakers usually refer to, which is are people staying on SNAP and continuing to receive benefits and are people working? But in principle separate from just getting a larger number or a larger fraction of people working, economic theory might predict that work requirements could increase income, either through the amount of work or the hourly wages among the SNAP recipients who were going to be working anyway, right? We find no effect on who's working, in other words, how many people are working. But in principle you might say, "Okay, maybe those who were going to be working anyway are now more attached to the labor force. They're working more hours or more weeks out of the year than they would've been absent the work requirements." As Adam said, we actually on average did not find evidence that work requirements increased incomes, and so we can't really say that work requirements improved labor force attachment on this dimension. We ran this analysis lots of different ways, and in the vast majority of our analysis versions, we found just no change in income. But if you were very motivated to cherry pick a couple of analyses in support of work requirements and ignore the totality of the evidence in the paper, then you can find a couple of versions where there's sort of suggestive evidence that a small fraction of potential SNAP recipients, maybe something like 10 to 15%, might have had some income increases that could be attributable to work requirements.

Now, I say that you would have to ignore the totality of evidence in the rest of the paper if you wanted to run with those results because it really only was a couple out of very many analyses, and the results even there were quite weak, especially compared to the very stark findings of no effect on whether people are working and very large negative effects on people's continued SNAP receipt.

Elena, thank you for that. Do you see any differences by subgroups? I realize that's not maybe a part of the paper as it's written, but knowing that different subgroups have greater unemployment, do you see any differences, say among racial or ethnic lines or along gender lines?

Elena - Well, we essentially couldn't find effects on whether people were working as a result of work requirements for any subgroup. We are somewhat limited in our ability to do subgroup analyses because of issues like sample size and statistical power, but to the extent that we were able to cut the data, we didn't see impacts on whether people were working for any of these subgroups, which is actually very different from what we see with people losing access to SNAP. So, we saw quite a large disproportionate impact on use of SNAP, meaning people's ability to stay on the program and continue to receive food assistance for individuals with a history of homelessness. Further, here was some suggestive evidence of disparate impacts along racial lines, but that wasn't statistically strong enough for me to feel comfortable claiming anything about it.

Adam, why do you think work requirements do not have much of an impact on work?

Adam - Our results suggest that the SNAP recipients that we studied likely face other barriers that are more important for employment than the work requirements policy itself. As Elena just mentioned, we found this disproportionate effect in terms of people who lack stable housing, and that can make it really difficult to hold down a job, and to be able to apply for jobs. People may also not have reliable or affordable transportation. So, without those things, you can see how it'd be very difficult for people to maintain gainful employment. Another possibility is that people's hours may fluctuate in ways that make them ineligible in terms of meeting the requirements of 80 hours a month, and so several of those explanations come from other studies of enrollees in different safety net programs in various states. One great thing about the data we had is that we could track people's earnings and participation in SNAP over a long period of time, but we don't see information on how many hours they worked, for example, or what their transportation options were. Those are issues, though, that many others have noted as being important in different contexts, both using quantitative studies as well as more qualitative studies. We think this is something that future research should really focus much more on - how to quantify the importance of those different barriers that ABAWDs likely face, and then trying to figure out how to best design solutions that address them.

This does make me think about another potential issue, and that's the benefits cliff. So, if someone is working and there is an increase in their wages, there actually could be a drop in their benefits that they receive from SNAP, and that could make this story a lot more complicated. Elena, I do have this question for you. How did you handle individuals who dropped out of having the ABAWD status, say if they had children or if a disability came up? Was this an important factor in evaluating that subpopulation?

Elena - For the validity of the study results, it was very important for us to keep a consistent sample throughout the time period that we were evaluating these outcomes over. This meant that if people were eligible for our sample definition at the beginning, then we kept them in the sample for the rest of the time period. That means that there were some people who dropped out of ABAWD status for various reasons, and actually, if I recall correctly, and Adam can jump in if this is not right, the most common way that people in the sample dropped out of ABAWD status is by having a newly documented disability. Our understanding is that what's happening with those folks is that many of them might have been eligible for a disability documentation that would've made them exempt from work requirements even during the time that Virginia had suspended work requirements. But there was essentially no point in their going through the hassle and their caseworkers going through the hassle of getting that documentation because the work requirements didn't apply to them anyway. So, when the work requirements came back, some at least of those folks got their disabilities officially documented so that they were, again, exempted from work requirements. This illustrates why it's important for us to keep a consistent sample before and after the work requirements come back, because we want to make sure that we're not sort of changing who's in the comparison group, right? You don't want apples to suddenly turn into oranges halfway through your study period.

Adam - Elena's description was exactly right, and in terms of the magnitudes of that response - in terms of people who were exempt for a reason other than their age - it basically doubled the proportion of people who dropped out of ABAWD status. On average, about 10% of people had some exemption besides age from ABAWD status, and then we saw that the policy increased that by 5.6 percentage points, so a pretty large relative change.

Bios

Elena Prager is an assistant professor at the University of Rochester’s Simon Business School. She is an empirical economist whose research is in the industrial organization of health care markets and labor markets. Prior to joining the Simon School, Prager was at Northwestern University’s Kellogg School of Management. She earned a Ph.D. in managerial sciences and applied economics from the University of Pennsylvania’s Wharton School, and an international Bachelor of Business Administration-Economics from the Schulich School of Business at York University.

Adam Leive is an assistant professor health economist at the University of California-Berkeley who uses large administrative datasets to study policy-relevant questions about health insurance and safety net programs. His research seeks to understand consumer behavior in complicated life-cycle decisions that impact economic security, such as health insurance and retirement saving. He has also recently studied the effects of employment incentives in safety net programs on labor market outcomes and program participation. He earned his Ph.D. from the University of Pennsylvania’s Wharton School and his B.A. from Princeton University’s School of Public and International Affairs. Prior to his doctoral studies, Leive worked at the World Bank and the IMF. 

There's much excitement out there about regenerative and organic agriculture, but how can they be financed and how can capital providers support these important approaches to agriculture? A new report by the Croatan Institute addresses this issue by emphasizing soil wealth areas. So, what does this mean? Well, we're going to learn about that from researcher Jamie Silverstein, an author of that report.

Interview Summary

So, let's begin with this. How is farm financing usually done and how does it come up short in this context of regenerative agriculture?

Sure. A lot of conventional farm financing comes from local banks and farm credit branches in the form of debt, operating loans, and lines of credit. These lending instruments tend to favor farms that grow commodity crops or raise animals in conventional ways. The farms often have a history of farming. They may come from farm families, they may have established relationships with these lenders and they're practicing agricultural systems that are very common and known, and the models have been proven out. The lenders are very familiar with these models. Regenerative and organic farms often have diversified systems. They're growing lots of different crops. They may be beginning farmers who don't have a long history of farming or come from farm families. All these factors make them perceived as riskier to the lenders. The other aspect of regenerative and organic agriculture is that they often are operating on longer time horizons. The implementation of these practices or transitioning to organic agriculture may take a longer time and may need more time to repay back a loan. Often traditional lenders are not as familiar with these systems or don't have the flexibility to extend the loan repayment times.

Okay, that makes sense. So, there needs to be some ingenuity here because the traditional models aren't applying. Can you tell us what a soil wealth area is? It's a very interesting term.

Sure. We define soil wealth areas as special purpose soil wealth improvement districts that act as magnets for investment in regenerative agriculture. I can break that down a little bit, starting with the word soil wealth. We coined that term in a 2019 report and it really encompasses both the environmental and social benefits of sustainable regenerative organic agricultural practices. A lot of people are familiar with the word soil health. So, that is building soil health. It's improving biodiversity, improving ecosystem services. But the other really important aspect is the people side the social side. So, how do we build social equity through these agricultural practices? How do we build wealth in rural communities, create resilient landscapes, healthier environments to live in? Looking at the term 'area,' we're referring to a district model that is actually pretty common in agriculture. There are conservation districts that have been established by USDA, NRCS, there are farmland protection districts and economic development districts. So, the reason behind why we're prioritizing this sort of place-based approach is that we think places is actually really important, and this helps build trust with the communities and the practitioners in these soil wealth areas. It helps to prioritize culture and heritage, social connection and the community dynamics of that region. So, the soil wealth area is a region or a a district that connects both capital providers with the capital seekers on the ground - so agricultural producers or value chain businesses - and it also can provide resources like agronomic technical assistance or business and financial readiness, technical assistance which also is really important in terms of the viability of these place-based businesses.

It's a very appealing concept because there's a lot more going on in a community or about district of land than just the number of bushels per acre. You're pointing to not only the soil health, but to the health and wellbeing of the people who live there and work there and things like that. It's a very interesting and and holistic concept. So, given this broad focus of this concept of a soil wealth area, how can financing be done differently?

That's a great question. I think financing can be done differently in a lot of different ways. There's not really a one size fits all when it comes to financing regenerative organic businesses. So, I can provide some examples of what that looks like. Sometimes it's one particular type of finance and sometimes it's lots of different types that are blended together. This could look like a low interest loan or a loan with flexible repayment terms that may come from a community bank or a CDFI. It could look like a loan guarantee or credit enhancement that actually enables a lender to make a loan they may not otherwise have been able to make potentially because of perceived risk or allow them to reduce the interest rates so that it becomes a little bit more viable for these agricultural producers and entrepreneurs. Through this research, other CDFIs and impact investors and peer-to-peer lending networks have come up with innovative and creative ways of how to finance place-based producers and practitioners. In addition, I think philanthropic capital and grants are also a really important part of this and that they can support farmers and entrepreneurs either directly, or they can help fund technical assistance that really helps support them understand the types of financing they need or makes the lender actually a little bit more confident in making that loan.

So, are there steps that can be taken to get to the point where these creative forms of financing are happening?

There is definitely the need to scale up this type of financing and access to capital for agricultural producers and value chain businesses. The model that we are proposing is top pair the soil wealth areas, this very place-based component, with a network of capital providers that may not be place-based. They may be national in scope. We want to help facilitate and coordinate these types of relationships. We call this whole ecosystem the Soil Wealth Community. And, then we have what we're calling the Soil Wealth Capital Collaborative. That is the network of capital providers that can come together, learn from each other, and use that network to allow them to expand and increase how much they are providing and able to fund regenerative businesses. 

Bio

Jaime Silverstein is a Senior Associate at Croatan Institute. She also sits on the board of directors for Metta Earth Institute. Previously, she has worked as a farm business advisor for NOFA-VT; crop R&D specialist for Freight Farms, a Boston-based urban agriculture start-up; program coordinator for Slow Money Boston; and senior research fellow at the Sustainable Endowments Institute, where she led research on responsible investing practices at colleges and universities. She holds a B.S. in Business Administration from Boston University and an MBA from the University of Maine. Silverstein has collaborated on various sponsored research projects addressing finance and sustainability, including “Soil Wealth” (2019) and “Institutional Pathways to Fossil-Free Investing” (2013). She has contributed to outreach and research, surveying institutional investors and money managers for the US SIF Report on US Sustainable, Responsible and Impact Investing Trends.

 Sugar replacements, known generally as artificial sweeteners or non-nutritive sweeteners, have been in the news a lot. Rising concerns exist about safety and the effects of the sweeteners on many key features of health, including the microbiome. We need the help of talented scientists to sort through this complex web of information. Today's guest, Professor Eran Elinav, has done some of the seminal research in this area. He's an expert on systems immunology at the Weizmann Institute of Science in Israel.

Interview Summary

So back in 2014, you and your colleagues published a study in the prestigious journal Nature showing that sweeteners could induce glucose intolerance - a highly concerning finding, What's more, they did so by changing the microbiome. Would you tell us a little bit more about this study and what subsequent researchers found.

In the study that published in Nature back in 2014, we explored the consumption of several kinds of artificial sweeteners when administered to mice. We wanted to ask a very simple but important question - are dose formulations of hypersweet compounds, which are so massively consumed by humans, in fact being responded to by our gut microbes. We know from our other studies that gut microbes contain a very well-developed machinery that enables them to respond and to digest multiple very complex formulations of food. We asked ourselves whether these seemingly inherent compounds could induce changes in the gut microbiome that could impact the health of these mice. And indeed, when we tested this, we mainly focused on saccharin, but in several experiments saw that could also be true for other common artificial sweeteners. We saw that the gut microbiome of mice being given saccharin in different concentrations, (using different strains of mice and different obesity conditions) were indeed capable of reacting to saccharin, changing their microbiome composition and behavior accordingly, and in some cases, resulting in a very surprising, counterintuitive worsening of glucose control towards diabetes. That was very concerning to us, because many millions of people worldwide consume artificial sweeteners with an aim of satisfying their sweet tooth without having to pay the caloric price. Especially people who are prone or already suffer prediabetes or even type II diabetes. What we could show was that the gut microbiome in some configurations could actually drive a disturbed control of sugar levels in the blood of these mice, which could suggest that in some cases, the gut microbiome could actually be bad for you when you consume artificial sweeteners in terms of your sugar management.

That is a landmark study by any standard, so congratulations for doing such important science. That was back in 2014. So what has research shown since then? 

We were able to prove in that study that consumption of artificial sweeteners was not only associated with changes in the microbiome and with the trend towards altered sugar control, but it was actually costly. We did this by transferring microbiomes from mice that were exposed to saccharin or to other artificial sweeteners into mice that do not have any microbiome of their own. They're called germ-free mice. We could see that these recipient mice who never consumed artificial sweeteners were developing the same exact disturbances in their sugar control just by the exposure to microbes that were previously exposed to artificial sweeteners. Now, this was very surprising, very important, and also caused a lot of backfire from the industry as one would expect. But it led to an array of follow up studies by multiple groups, mainly in other mice models and utilizing other formulations of artificial sweeteners, which basically suggested that our observations were correct. Artificial sweeteners were not inert when given to mice in different contexts and disease states. Now, the biggest limitation of our original study and all these many follow up studies was that all of these experiments were conducted in mice. The billion-dollar question was, can we recapitulate these findings at least, to some extent, in the human setting? This prompted us to perform a very ambitious human clinical trial which took multiple years to complete. It was finally published a year ago. The take home from that study which focused on all four commonly consumed artificial sweeteners was the concept that we've highlighted almost a decade ago - it was correct when applied to humans.

Those findings raise alarms on many different levels. I appreciate you sharing that information with us. Recently, the World Health Organization has expressed concern about the sweeteners and their impact on people's ability to control body weight and health, and even risk for cancer. One of the counters from people who are in favor of these sweeteners is that the doses provided in these studies are many times what a human might ordinarily consume. What do you say to that?

I will say two important things. First, this may have been true in previous studies a decade ago in which we all started by testing artificial sweeteners at relatively high doses. However, with years of follow-up studies and the expanded field of the doses of tested artificial sweeteners that were in many cases, reduced to those below the recommended daily allowance in humans. And, in the controlled clinical trials published a year ago, doses of four artificial sweeteners that we supplemented our participants were well below the recommended daily allowance. And still in some people, we could see that these seemingly inherent compounds were able to reproducibly change the microbiome and to change to our configuration which could induce alterations in blood sugar control in these individuals. When those microbiomes were transferred to mice that had never seen artificial sweeteners, the microbiome integrations could also induce identical disturbances of blood sugar control in transfer mice. So, I think that our studies and plethora of other studies generate knowledge suggesting that artificial sweeteners may not be natural to the human body even when consumed in conservative doses.

Well, thanks for that clarification. You mentioned some pushback from industry. Tell me what form that took. Was there a particular player in industry that was doing the pushback? Did you think that their concerns were valid?

Well, I think that it is a natural part of the evolution of a set of discoveries that have a direct impact on human health and human nutrition. And also, of course, economic considerations. Some of the claims were less than fair, and others were more relevant. One needs to understand, and I'm saying this both as a physician and as a scientist, especially given our early studies, that you can make the best effort that you can and comprehensively try to tackle a question. But there are always things people can claim that were not done or should be done better. Science is not a one-shot profession. We come up with a discovery and then we build upon it, and others also come in, validate it, build upon it, and this was the process. So, I take everything with love. Many other people have experienced a healthy discussion with the industry, and I think we've all matured into understanding, at least in our group, we are not against artificial sweeteners or any other food compound. We are just keen and interested in learning how different food compounds including artificial sweeteners, impact our body in unforeseen ways, and we focus on the gut microbiome. This huge and poorly explored ecosystem, which we now understand is an integral part of our body, has amazing biochemical capacities to degrade and respond to almost any substance. With artificial sweeteners, I think that this revelation is actually very helpful to the industry because with this knowledge, and knowledge that is added by others, we are hopeful that by understanding that artificial sweeteners are not inert to the human bodies, we would be able, together with the industry or with whoever is interested in helping this effort, understand which formulations are safer than others. Which doses are safer than others; and which are the human populations at risk, who should think twice before they consume these compounds. While others could consume them and enjoy them with relatively little risk. I think this maturation of our knowledge and maturation of the field is, in general, a very positive one.

So, with respect to the impact of these sweeteners on the microbiome, is there reason to have special concern about children?

When we conduct human clinical trials, we're always hypersensitive about special populations at risk such as children, people who are incarcerated, and so on and so forth. We usually tend at least in groundbreaking first human trials, such as the one that we've conducted with artificial sweeteners, we try to avoid these at-risk populations just so our initial observations are based on populations that are not at special risks. So, children, as you know, are always a special population that we're even more concerned about than a general population. Our own setting was not inclusive of children, though our inclusion criteria included healthy adults 18 years of age and older. So, with respect to children, I can say that our own data did not explore them to date. But in general, we are always especially concerned about children. Any potential metabolic perturbation during that critical growth window for children is of special medical concern to us.

Let me ask you one final, big-picture question. The defenders of these products are basically implying, if not sort of stating directly, that the pursuit of sweetness is a reasonable thing to have and that these products can deliver the sweetness that people enjoy, but potentially without negative effects. That's the position. But what about that basic proposition that the pursuit of sweetness is a reasonable thing to do, because couldn't one say that this pursuit, whether it's delivered or whether the remedy to wanting to have more sweetness comes from either sugar or artificial sweeteners, there is potential to be harmed. Wouldn't it make sense to just gradually reduce the level of sweetness in the food supply, so that people become accustomed to less sweet taste overall?

I couldn't agree more with your statement. I have to say that our findings related to the non-inertness of artificial sweeteners and the potential adverse impacts on human metabolism do not imply in any form or shape that we recommend that people convert back from artificial sweetener into increased consumption of sugar. We know from endless medical literature that sugar is probably an ultimate evil when consumed in excess and is directly responsible for contribution to multiple human diseases including obesity, type II diabetes, fatty liver, and even other diseases including cancer. So going back to sugar would be a big mistake. But I totally agree with you that positioning the public opinion as one which must choose between two sweet solutions, either sugar or non-nutritive sweeteners as the only options, basically is biased because we as a post-industrial revolution human population, have dramatically increased our sugar consumption. I don't think that we need to choose between these two options. I personally opt to go back to water rather than choose between these two options which carry along probably adverse health consequences, at least in some human populations.

Bio

Eran Elinav is an Israeli immunologist and microbiota researcher at the Weizmann Institute of Science and the German Cancer Research Centres. He is an international scholar at the Howard Hughes Medical Institute and the Bill & Melinda Gates Foundation and a senior fellow of the Canadian Institute for Advance Research. Elinav studies the molecular basis of host-microbiota interactions, and their effects of diet, environmental factors, immune function and host genetics on the intestinal microbiome and associated multi-factorial metabolic, inflammatory malignant and neurogenerative disease. His most-cited papers have more than 2,000 cites each. Elinav developed precision microbiota interventions, including Personalized Nutrition, Precision Probiotics, small molecule ″postbiotics″, Phage Therapy, autologous fecal microbiome transplantation, Vaginal Microbiome Transplantation (VMT) and gut epithelial interventions.

The microbiome is fascinating and how diet affects it is something we all want to know. The work of today's guest, Dr. Abigail Johnson, tells us a lot. She's on the faculty and the School of Public Health at the University of Minnesota and is an expert on diet and the microbiome and their impact on health and disease.

Interview Summary

So there's an awful lot of interest in your work but let's start with kind of a broad question. So there's much talk in the news and obviously in the scientific world about the microbiome and one fundamental question is this, how much should we pay attention? How important is this all? Is it important enough for dietary recommendations to be modified? For policies to be affected? Give us the big picture from your perspective.

I think it's really important. I wouldn't be studying it if I didn't think it was important. I think that there's so much that we don't know about what all of the microbes that are in and on our bodies are doing that impacts our health. There's just so much that we don't know at the moment that I think it's very important that we continue to study it. From a nutrition perspective which is where I spend my time, I think that there is a lot of potential that we could eventually understand how we can use food to change the microbiome. From that perspective, we might get to the point that we can make recommendations that affect national nutritional guidance like the Dietary Guidelines for Americans, for example. I don't know that we are there yet, but I do think that we are learning more and more with every passing year that gets us closer to being able to say some things definitively.

That's consistent with the way I've been seeing it and it's nice to hear it affirmed by an expert. So, your research on diet and health uses, and now I'm quoting from your website, "novel computational methods," can you explain what the methods might involve and how they improve the assessment of what people eat?

I did my postdoc with Dr. Dan Knights here at the University of Minnesota. I joined his lab as a nutrition scientist with very minimal background in statistics but an interest in computer science. I told him when I joined his lab that I wanted to learn to code. I immersed myself in this world of people doing bioinformatics and using computer science and bioinformatics to answer questions about the microbiome. What I noticed while I was in my postdoc was that a lot of the questions, statistical problems, and computational problems that exist in the microbiome space where people are coming up with unique ways to solve those problems mathematically are really analogous to issues that the field of nutrition has also been grappling with - sort of since its existence. When I say novel computational methods, I'm often referring to really stealing methods from the microbiome space and applying them to nutritional data. Like microbiome data, nutritional data have these sort of strange qualities that make them interesting from a mathematical standpoint. To be more specific, I've developed an approach that uses trees. In microbiome space we use phylogenetic trees to share information in statistical approaches to understand how communities are different. For example if we both haves E. coli species and they're actually different species, we can still use the fact that they're both E. Coli to understand the similarities between our different microbiome compositions. In the nutrition world, we think about foods as they fit under umbrellas of food groups. I've basically stolen the method of using trees in the microbiome and applied that to nutrition. That's kind of the novel computational approach that I take when trying to understand diet and dietary patterns.

That sounds like a real advance. What are some of the highlights of your work on microbiome in the diet?

In my work, I've been able to find signatures. We can pick up the signature of what you ate in your microbiome and the way your microbiome changes. We can link that back to your diet on a daily timescale. So if we have information about what you ate in the three days prior to providing a microbiome sample, then we can make some prediction about how your microbiome is going to change the next time we sample you. So not really good at predicting how it's going to change yet, but at least if we have the data, we can link you up with your diet and understand that the changes that happen in your diet show up in your gut microbiome. Also, being able to identify to some level of specificity, how much of the variation in microbiome, be it across populations or within an individual, can be connected back to differences in dietary intake.

You know that work that you're doing on using the microbiome as a measure of what people eat is a real advance, isn't it? For so many years the nutrition field has relied on people's reports of what they eat to make judgements about the relationship between diet and health and even individual dietary recommendations. But it's hard for people to be accurate about that. Having something like this could be a real breakthrough, couldn't it?

Yes, I'm really hopeful. We're not there yet, but in my dream we would be able to take a fecal sample and know something about what you ate and that could help us avoid having to do dietary recalls, for example. We can get past this fact that people can't remember what they ate. That's sort of the dream where I see methods development going in the future.

One of the titles of one of your papers really fascinated me and the title is this "US Immigration Westernizes the Human Gut Microbiome." That's really fascinating. Can you tell us more about that study?

Yes, so this was a study that took place in Dan Knights Lab at the University of Minnesota. It was led by Pajau Vangay, and she's an incredible computational scientist and food scientist. She is also a second generation Hmong immigrant to the United States. So I was lucky enough to support her work. She was the one who led this study and basically the study to evaluate microbiome samples from groups of Hmong and Quran immigrants (there happens to be a large Hmong and Quran immigrant population in the Twin Cities in Minnesota). They asked could we collect microbiome samples from these groups of people? Many of them came to the US during the Vietnam War. So there is a time course to look at. We've got first generation and second generation immigrants. They collected samples from first generation, second generation immigrants. Pajau went and visited a refugee camp and was able to get samples from people who were still living in Thailand. And, a small group of people who actually moved to Minnesota during the time that she was collecting data. She got this rich data set as well as information about diet from all of these people who participated in this study. We were able to see a trend toward the microbiome changing from the Thai sort of looking microbiome to a more US looking microbiome when we compared across this continuum to people who were born in the United States. It was really cool. The first question that everybody who sees this data asks is well, it must just because of dietary acculturation, right? You move to the US and you start eating Big Macs and burgers and that's what changes your microbiome. What we actually found, which is very interesting, was that the dietary shifts didn't really account for that much of the changes. We were able to attribute about 16% of the change in variation that happened in the microbiome to changes in diet - so dietary acculturation - but it wasn't as much of the variation change that we expected we would find. It leaves a lot of questions out there about what is causing changes in the gut microbiome when you move to a new location. Is it because of the food? We know that some of that can be explained by food, but there's also this unexplained variation that we're still interested in figuring out what's driving it.

Boy, you're right. That's a very cool result. I was going to ask about the acculturation issue because I know when people move from one country to another, their food habits are some of the things that will live the longest in the new culture. The fact that you're not finding diet to be 100% responsible for that finding is really interesting. Is there speculation about what it might be?

Yes, we have some theories. We speculate a little bit about could it be environment that you live in. You know, are there microbes that you're coming into contact within your environment, microbes that you're coming into contact with by interacting with new people living in new spaces, going to work in new environments. Could it be that there was something that we didn't measure? Like were you given a lot of antibiotics or antifungals at the time of immigration that we didn't capture properly? We did capture information about antibiotic exposures but maybe not enough information or is there something about the water that you drink when you moved to the US that's different? Those are sort of some of the theories that we had around what might be explaining some of the variation. 

Do you think it's within the realm of possibility that greater exposure to the forever chemicals that are coming in things like plastics and food wrapping and water bottles and spinoff from tires and things like that could be contributing?

I don't know. It's a good question. How would we study it?

I don't know. I'll have to rely on you for that but I can imagine it shows how complex the issue is because when people move from one place to another, there are thousands of things that are changing and isolating any one of them is not easy. Thank you for the description of that study. It's really interesting. Now I'd like to ask you about precision medicine and precision nutrition. These terms are coming up more and more. What is precision nutrition and how does the microbiome fit into the picture?

Great question. Precision nutrition is a really interesting and exciting concept. In clinical dietetics, if you asked a clinical dietician, they would tell you that what they do is already precision nutrition. They work with patients who are trying to control their cholesterol or manage their diabetes and their blood glucose, and they provide personalized dietary recommendations based on what that person usually eats and what they want to see change in their biomarkers, for example. If you talk to a clinical dietician, they will tell you that they already do precision nutrition. But what I think we are starting to move towards and what the excitement is around is that precision nutrition could be using big data to do that type of individualized nutrition advice for big groups, almost population level nutritional recommendations. Where the microbiome fits in is that there was a pivotal study by Zeevi et al that linked changes in blood glucose response to foods to individualized signatures that were in part informed by the gut microbiome. There's a lot of excitement that understanding the gut microbiome might help us to better provide precision or precise nutrition recommendations to people with big data. That's how I conceptualize precision nutrition right now.

For the people listening who may want to do everything they can to have a healthy microbiome, what are the dietary things they might consider?

I don't think that we have a clear single answer for this but when I'm asked this question, I come back to three dietary features that seem like, at least in cross-sectional observational studies show up again and again. The first is dietary fiber and getting enough dietary fiber. There's some pretty good evidence that the amount of dietary fiber that we currently recommend, around 28 grams a day, give or take a gram or two, depending on your specific needs, that amount of fiber is probably good for your gut microbiome. There's some evidence that may be going up to say 35 grams of fiber per day might be beneficial. The piece that goes on top of that from a microbiome perspective is potentially having a diverse variety of fiber types. We often talk fiber about as this monolith but really fiber is a whole bunch of different biochemical components, non-digestible parts of plants primarily that feed our gut bacteria. Getting diverse variety of fibers is probably important. To do that, it looks like getting a variety of plant foods into the diet is what might be most important to support a quote unquote "healthy" microbiome. Although a caveat that we don't really know what a healthy microbiome looks like yet. When people talk about healthy microbiome, they're often mostly talking about having a higher diversity of gut microbes. The third piece of the puzzle, at least from what we understand at the moment, is that possibly adding fermented foods and maybe specifically fermented vegetables or fermented plant foods may be beneficial for the gut microbiome. So those three things - diversity of plants, and diversity of fiber that kind of goes along with that, and then some sort of fermented food - those look like the three things that might be beneficial from my perspective.

Let me just ask about the fermented foods for a second. So I hear people talk about yogurt, kefir, things like sauerkraut and kimchi. Are these sort of things all kind of interchangeable with one another as people think about adding fermented foods to their diet? Or are there some that would be preferable to others?

I don't know if we know yet. We have a lot of good data going back many, many many years looking at fermented dairy. Most of our research in the nutritional literature looks at fermented dairy - so yogurts. More recently we are starting to get data to look at things like kefir, but there's not very much literature available looking at fermented vegetables like lacto-fermented vegetables. Like your sauerkrauts and your kimchis. I think it's an active area of research. We need to do a lot more work in that space before we can make more specific recommendations. Right now, I would lump them all together but from my perspective, I suspect that a fermented vegetable might have different impacts on the gut microbiome when compared with a fermented dairy product.

Okay, thanks. It's a fascinating question and it sounds like as the research marches ahead that we'll have some answers to that. Let me ask kind of a big question to end. It strikes me that there's real cause to be optimistic here, that there's a kind of a whole new level of understanding about diet and health and how the microbiome is playing a big role in that. We might be headed toward the point where there are some policy priorities that would be in place or some dietary recommendations. Do you think it's too early to be thinking about those or are there some things we could say now?

I think it might be a little bit too early. I think what we really need to do as a field is to make sure that we are thinking about everyone when we're doing this research. By that I mean that we're enrolling diverse groups of people into our research studies so that we're not only learning about precision nutrition and the microbiome from this white American centric approach. Then, I think once we have a diverse data pool to look at, including different eating traditions that are not just western eating traditions, then we might be able to make some of these steps towards enacting policies or making recommendations at the population level that incorporate some of these precision nutrition or microbiome targeting approaches. I think the first step is just making sure we're doing really solid research that doesn't leave anyone out and that we're not just doing precision nutrition for people who have a lot of resources.

Bio

Abigail Johnson is an assistant professor in the Division of Epidemiology & Community Health at the University of Minnesota School of Public Health. She is the Associate Director of the Nutrition Coordinating Center there. Her research explores the relationships between diet and the human gut microbiome in health and disease using novel computational methods for dietary data. She focuses on 1) analysis of diet and microbiome after dietary interventions, 2) methods development for dietary data analysis and visualization, and 3) understanding the interactions between foods, microbes, and fungi during different stages of development. She is interested in exploring how diet and the microbiome interact to influence chronic diseases including prediabetes, diabetes, and cancer.

If you want to improve your digestion, your immune system, and your overall health, one might begin with a focus on a healthy gut microbiome. Today we're talking with Stanford University professor of microbiology and immunology Dr. Justin Sonnenburg, co-author of the book entitled, "The Good Gut: Taking Control of Your Weight, your Mood, and Your Long-Term Health." He and his wife, research scientists Dr. Erica Sonnenburg, argue that our typical modern diet has caused the microbial diversity or intestine to shrink substantially. Turns out that's a big problem.

Interview Summary

My impression is that this field of work on the microbiome is just exploding. It seems like every day something new comes out, something exciting, some kind of major breakthrough. It's wonderful to have a leading scientist like you to join us to help explain this. Let me begin with this question. I recently read something very interesting in the article that discussed your work, namely that you've hypothesized, and this is a quote from this article, "Humans may merely be elaborate vessels "designed for the propagation of bacterial colonies." Now that's pretty interesting. Tell us more if you would?

Yes, absolutely. I should note that this is an idea that has been propagated, just as microbes are propagated over time. I did say that, but I'm now attributing it to the great scientists that came before me. I will say that the microbes in our gut have been for a long time a curiosity. For hundreds of years we've known that they live there. Over time we've learned that they're affected by what we eat. We know that they're involved in digestion and gut health. But what is really phenomenal is, as you alluded to in the introduction just the ability of these microbes to impact so many dimensions of our health. Everything from our immune system, to metabolism, to things like moods, behavior, and neurodegeneration. When you start to think about microbes getting passed from generation to generation - because as a new baby is born, their gut is sterile in the womb, and then they're rapidly colonized when they come to this world largely by microbes from their mother and other adults around them - you start to realize that these microbes may actually be the ones calling the shots and dictating aspects of our biology to promote their growth through evolutionary time. It does change the way you think about this relationship in some ways.

One might jump to the conclusion that microbes are a bad thing, and you'd like to have fewer of them. That's in fact what antibiotics do, they get rid of them. But we need more rather than less, and it sounds like the shrinking diversity of the microbiome is really a problem. How do our diet and lifestyles damage the vitality of the human microbiome? I'm imagining this is a 'let me count the ways question,' but what are the leading concerns in your mind?

Yes, completely. I think you're right in that it's very hard to single out one particular factor, because as populations become more industrialized and embrace all of the technologies and medical practices that go along with the industrialized lifestyle, we have so many factors that can impact our microbiome. Certainly, diet is a major factor, and we can come back to this. But we know that most of the microbes in our gut reside at the far reaches of our digestive tract - at the very end of the line down in our colon in our large intestine. That means that if we're eating simple nutrients, like most of the things in a western diet - sugars, starch, fat, protein - a lot of those things get digested and absorbed in our small intestine, which leaves nothing remaining for the microbiota. It's really complex carbohydrates and dietary fiber, that serve as the major fuel for the microbiota because we can't digest those complex carbohydrates. The western diet has greatly reduced dietary fiber content, which has left a lot of our gut microbes starving. But there are other aspects of diet, certainly artificial sweeteners, emulsifiers, and probably the high fat content of the western diet are not great for our microbiome. Then beyond diet, antibiotics as you mentioned known to be great for fighting infectious diseases, but not so great for maintaining all of the friendly microbes that we harbor in our body. A variety of other factors like C-sections, baby formula, the incredible sanitation in our environment, again, a lot of these things are a trade-off because we have reaped a lot of benefits from a lot of the lifestyle medical practices technologies. But at the same time, we've implemented these in the absence of understanding the importance of our gut commensals, and the other commensals on our body for our health. Now we really need to start thinking about do we need to restore diversity to this community? Certainly, we need to start thinking about taking care of the community more diligently.

You mentioned in some detail how diet affects the gut, but how does it happen in the reverse? Is there a reciprocal relationship going on?

Yes, it's a great question, and there are some papers that have been published looking at how gut microbes can affect food choice in model organisms like fruit flies and other organisms that are studied in the lab. We know that microbes in the gut as they metabolize things are producing a lot of interesting chemicals, little metabolites that get absorbed into our bloodstream can circulate through our body. Certainly, some of them cross the blood-brain barrier and can interact with our central nervous system. Now, whether some of those molecules can actually impact our food choice, I think is an interesting topic, we don't know a lot about that. You can imagine a microbe that's really good at, for instance, degrading pectin and it might grow very well. We know there are many microbes that grow well when we, for instance, eat an apple. If that microbe happens to produce a molecule just by chance that then can go in and increase our craving for an apple, that microbe has hit the jackpot for proliferating, it can guide our actions to choose an apple and then it actually profits from the pectin that comes in when we eat the apple. While this would be a very rare quirky event to happen, when you think about the trillions of microbes that exist in every person and have existed in every person across the planet throughout time. It's possible that things like this have happened, and it's a matter of us as scientists trying to track down those stories.

There's at least some optimism that there could be virtuous cycles that gets set up rather than these destructive cycles potentially. Help us place this in some sort of a context. You talked about a myriad of dietary things that could affect the microbiome, and probably other things out there in the world too. How serious is the impact?

Yes, and this brings up kind of the question of what is a healthy microbiome? Has lifestyle impact that our microbiome? What would be ideal would be to have a time machine to go back, and actually survey what the microbiome looked like thousands of years ago before industrialization, and maybe even going back greater than 10,000 years to what our gut microbiome looked like when we were hunter-gatherers even before we started farming. Just to get a sense of what are the microbes that humans harbored over long periods of time during our evolution with the idea that perhaps our human genome was shaped over evolutionary time in some way by these microbes, that we have adapted our human biology to deal with the specific set of microbiome features or species. We don't have a time machine, but there have been groups that have surveyed paleo feces for instance - the fossilized stool from humans from 1 to 2000 years ago. These data indicate that the microbiome has changed drastically. As we have industrialized, we have totally departed from this more ancestral microbiome. The other way that we can gain insight into this is by looking at modern humans that live lifestyles similar to our ancestors. Hunter-gatherer populations and rural agriculturalists, and we've done a lot of work studying the Hadza hunter-gatherers of Tanzania looking at their gut microbiome. That exactly supports what the paleo feces have told us. That there were features in the microbiome from before industrialization that have changed drastically. We've lost species, they've gone extinct. Hunter-gatherers and many rural populations still harbor these microbes. We expect that there's probably around 500 to 1000 different species of bacteria in an individual's gut microbiome. We've lost hundreds of these species over the course of industrialization. Then, the flip side of that is hundreds of other species have come in and replaced them. We've actually had this kind of wholesale change in configuration in our gut microbiome, and what this means to our biology, we're trying to figure out right now, but it is a really marked change.

I have to say I admire the breadth of your work all the way from basic laboratory studies to in the field studies with hunter-gatherers. I could see how your big picture view of this is really pretty unique. Let's talk about how the gut communicates with the brain, and does the health of the microbiome affect things like eating regulation? We've talked about that a little bit already, but also things like mental health.

I just want to start by saying that this is a field of research that is in very early days still, we have a lot of work to do to really figure out the connections. You can imagine then the gut microbiome composed of hundreds of species, and then trillions of cells and changing over time within an individual, and different between individuals, and then secreting thousands of chemicals that go into the bloodstream. Then put on top of that the complexity of the central nervous system and brain, and then try to map the interactions between the microbiome and the central nervous system is exceedingly complex. 

I think that one of the really important things to note here is that if you look at a lot of the anxiety, and depression, Alzheimer's disease, neurodegeneration in general at this center of a lot of these diseases much like other diseases of the industrialized world lies inflammation. The immune system actually becoming too inflammatory, and that leading to, you know, in some cases autoimmune diseases, but in other cases Alzheimer's disease, and/or anxiety and depression. One of the things that our lab is focused on is really trying to understand how when you change the gut microbiome, how does the immune system change? How does the inflammatory status change of the system? Because we really think that this is the key mediator of many of the things that have gone wrong including things like diabetes and metabolic syndrome. 

We're now at the point of understanding that certainly if you go into an animal model and you change the gut microbiome in a major way like industrialization has changed the microbiome of people living in the United States, you completely change how the immune system functions. You can really change how an individual would react to a respiratory infection, how well they would respond to an immunotherapy if they were battling cancer, you can just completely change immune system functionality. In trying to understand this better we've started to do dietary interventions in people to see if we change the gut microbiome in beneficial ways with diet, can we make the immune system less inflammatory? We've done this so far in healthy adults, and now we're really interested in extending this into all sorts of populations that are suffering from different inflammatory diseases, including things like anxiety, and depression, and neurodegenerative diseases. We'll have more information about this. There's some beautiful fundamental research out there that shows unequivocally that the gut microbiome is regulating behaviors, and cognition, and fundamental aspects of what happens in our brain. But a lot of this has been done in animal models, and it's very hard to extend to humans in a detailed way.

I can't wait to see these studies, they're just absolutely fascinating and so important. You know, something occurred to me as I was thinking about this, and this may be outside the area of work that you're focused on, but there's a lot of interest out there in the world and the impact of endocrine disrupting chemicals, or things that leach from plastics and things known as forever chemicals, and their impacts on a whole host of things like cancers, and obesity, diabetes and more. Is there any reason to worry about the microbiome in this context?

Yes, completely. I think everything that we come in contact with, particularly things that we ingest, but even things that are absorbed through our skin or we inhale, the microbes that live in and on us are just incredibly sensitive detectors of everything going on in the environment. I mean, their survival depends upon it. One of the, in fact, key features of one of the first species from the gut microbiome to have its genome sequenced, Bacteroides thetaiotaomicron this is a bacterial species that was sequenced in the lab of Jeffrey Gordon, it was published in 2003. One of the key interesting features of that genome was the expansion of environmental sensors that were encoded by that genome. It was very clear that this bacterium was living in a dynamic environment, and having to sense and respond to minute to minute variations in the chemical cues that were coming in. That means that when you start to change those chemical cues, you start to change the function of the microbiome because those sensors that those bacterial encode are wired into their function and how they behave. This is again, hypothesis, but I think your question is a a great one because there are these realms of inquiry where we are just right at the beginning of understanding that major things that are going on in our environment could be impacting this really essential component of our biology. And we really have no specific idea of how the perturbations may cascade through our microbiome and our biology. A lot to look at there, but I have no doubt that those chemicals are having an impact on this community filled with environmental sensors.

It's going to be so interesting to see that work take shape. It would be great if community of people working on the microbiome could come together with the people in interested in the impact of these forever chemicals on health so that a full picture of their impact can get painted. So what do you think are the most pressing scientific questions that need to get addressed?

I think that we're still really searching for the definition of a healthy microbiome. And this is something that dates back to a wonderful project that was started by the National Institutes of Health, the Human Microbiome Project. That was an effort from sequencing centers that had sequenced the human genome to turn these sequencing technologies to this uncharted aspect of our human biology, our microbiome. One of the goals of that sequencing project was to determine what a healthy gut microbiome is. And our assumption at the time was, well, we should sequence a bunch of healthy Americans, and kind of look at what's common between them. We now understand that the healthy American most likely harbors a microbiome that is not really optimal for health, it's actually probably a microbiome that's predisposing us to a number of inflammatory conditions.  

Our human genome probably dictates whether you as a person will get an autoimmune disease, or cancer or you know, a different inflammatory disease. But it's really a microbiome that appears to be pro-inflammatory, and so that doesn't mean that it's terrible and that we need to scrap the whole thing. But it means that it probably can be improved. A big part of that improvement probably can come through feeding it better food and getting better functionality out of the microbes we have. But it also probably means that we need to bring back certain functions or certain species that we've lost over the course of industrialization, to bring back some of that biodiversity. 

You know, I think of the microbiome as similar to this complex rainforest, just hundreds of species interacting in this really dynamic way, and as you start to degrade that ecosystem it's really hard to maintain its full functionality. You start to lose functions, and it starts to operate suboptimally. And so thinking about ways to bring back the health and biodiversity of this ecosystem, I think is super important. One of the key things that we have to do as a field, and I want to just reflect back on the work that we're doing with hunter-gatherers and implications for what might be a healthy microbiome. It is not at all clear that all of the microbes that we've lost are healthy and need to be reinstalled in our gut. I think that we've probably lost species that we, you know, just as soon not have. But mapping which ones are health-promoting, and in which context, because you know, what's health-promoting for one person may not necessarily be health promoting for someone else that's going through something very different in their life in a different life phase. So we need to understand all that complexity, and really crystallize how can we optimize a microbiome for an individual in a given context. 

This sounds like a really complex problem, and it is, but I think that one of the really exciting things that's happening in the field right now is this combination of what we call omics data, the ability to measure so many different aspects of the microbiome at one time so we can get a really detailed picture. Then all the great computational approaches for bringing all that data together, using things like machine learning and artificial intelligence on big data sets to really distill out meaningful signals that give us a better idea of some of these complex questions. It is a complex thing to go after, but I think it's not out of reach and that's I think the big frontier for the gut microbiome.

Well, speaking of the big frontier, let's end with a big picture question. What can be done to make things better? You mentioned improving diet would be one thing, but how do you look at those big picture questions?

One of the incredible things about the gut microbiome and its relationship to its human host, is this like feedback system. For instance, if you are in a slightly inflammatory state, it can be hard to get out of that inflammatory state because the inflammation is reinforcing microbes that are then reinforcing the inflammation. You end up with these feedback loops that are very hard to break, so even if you were to do something like a fecal transplant in some instances of inflammation where you try to reinstall healthy microbes, those may not engraft and take up residence because the host inflammation will get rid of the good microbes and select in the microbes that feed the inflammation. There are these feedback loops that are very hard to break, and we know the gut microbiome is very resilient, so you can perturb it and it will by and large return to a starting state, not exactly what the starting state was, but there is this great resilience and recalcitrant to change over short time periods. This is why industrialization has been so powerful because it's happened over multiple generations across an entire population, and it's driven our microbiome in one direction. 

I think if we want to bring back a more diverse healthy microbiome, it requires changes in our habits, changes in what we eat day after day for years on end to really change the species that are in our microbiome and what those species are doing. We got a little bit of insight into this, but I'll finish with one specific example. One of the dietary interventions that we did, we compared a high fiber diet, so this is eating things like legumes, whole grains, vegetables, fruits, thinking that that would be kind of optimal food for a healthy gut microbiome. We compared that diet with a high fermented food diet, so another cohort of individuals, we gave kombucha, kefir, yogurt, kimchi sauerkraut, food with living microbes in it that had been transformed by fermentation. Basically, so these were just healthy adults we let them eat those foods, they ramped up on the foods for four weeks, and then for six weeks they maintained high levels of those foods. We actually saw that the high fiber diet had very different effects on individuals depending upon their starting microbiome. If you had a very diverse microbiome to start with, you actually improved your inflammatory status, you got less inflammatory over the course of the intervention. But if you start with a low diversity microbiome, the high fiber diet doesn't do much for you. The fermented foods actually had a really amazing effect, they increased microbiome diversity and they also decreased over two dozen inflammatory markers that we were able to survey through these great technologies that give us comprehensive immune profiling. We really saw a signature of exactly what we'd want to see to counter the industrialized deterioration of the gut microbiome with the fermented food diet, increased microbiome diversity, decreased inflammation, and this was just over the course of a 6 to 10 week intervention. We're really curious to pursue these findings in more detail, and see if now we can go into diseases that are pro-inflammatory, and counter those diseases to actually treat them in some way with the fermented food diet. 

If I were to tell people what to do to counter all the negative impact of industrialization on our microbiome, I would say consume some fermented foods every day, and then start to integrate dietary fiber. As you eat the fermented foods, you'll increase your microbiome diversity. And our hope is that will allow you to harness the benefit of the high fiber diet as your microbiome diversity increases.

Bio

Justin Sonnenburg is a professor of microbiology and immunology at Sanford University. His research focuses on the basic principles that govern interactions within the intestinal microbiota and between the microbiota and the host. He is the coauthor of The Good Gut: Taking Control of your Weight, Your mood, and Your Long-Term Health.

Today's podcast is a continuation of our series exploring the safety of non-sugar sweeteners in both food and beverages. In 2022, the World Health Organization conducted a systematic review of the most current scientific evidence on the health effects of non-sugar sweeteners. This analysis of 283 studies reveals that non-sugar sweeteners can impact health conditions such as cardiovascular disease, type 2 diabetes, adiposity, bladder cancer, and preterm birth. In 2023, the WHO released a guideline on the use of non-sugar sweeteners based on this 2022 review. Our guests today are Dr. Jason Montez, scientist with the World Health Organization, and technical lead on the systematic review and guideline. And, the director of the Department of Nutrition and Food Safety at the World Health Organization, Dr. Francesco Branca.

Interview Summary

This is really important work, so let's get right down to it. So, Francesco, let's begin with you. Would you help our listeners understand why the WHO, developed this guideline, and what do you hope to accomplish now?

Francesco: So our interest in the topic really came after the release of the WHO Guideline: Sugars Intake for Adults and Children in 2015. That recommendation was, of course, to reduce the amount of sugar to less than 10% of energy, and better if less than 5% for weight control and for dental hygiene. At the time, there was an interest, particularly from the food and beverage manufacturers, to consider the use of non-sugar sweeteners as part of the interventions in reducing sugar intake. This has been taken up by consumers since, and the availability of non-sugar sweeteners has increased. We thought it was important to review the evidence in a systematic manner, and to see whether this move was actually achieving the intended aim to control weight gain. So we thought of looking at non-sugar sweeteners use through the WHO guideline development process. Our hope, first of all, is to make sure that people achieve their intended health benefit, but also to avoid an unintended consequence on health.

I remember how much impact that report on sugar had, back when WHO released it. And boy, the same thing seems to be happening with the guideline that We are talking about today. So Jason, can you walk us through the key findings of the systematic review?

Jason: Sure. So the top line results of the systematic review are that in short term randomized controlled trials mostly lasting three months or less, those consuming higher amounts of non-sugar sweetener, compared to lower amounts or no non-sugar sweetener, has slightly lower body weight. So around 700 grams. And, slightly lower BMI; about 0.2 units. However, in long-term prospective cohort studies, many with several years of follow-up, body weight was either unchanged, or greater in those consuming higher amounts of non-sugar sweeteners. In addition, associations were also observed between non-sugar sweetener intake and increased risk of type 2 diabetes, cardiovascular diseases, and premature mortality. For diabetes, for example, we found about a 25% increase in risk. In RCTs - markers of these diseases - such as blood glucose, insulin, cholesterol, blood pressure, were largely unaffected by non-sugar sweetener use. In addition, we saw an increased risk of bladder cancer coming from case control studies and it was primarily driven by saccharin. Also, a 25% increase in risk of preterm birth in pregnant women in terms of body weight, and the risk of non-communicable diet-related diseases. We essentially have seemingly opposing results between the short-term randomized controlled trials and the long-term cohort studies.

Those are really concerning findings. Somebody in their own calculus might say, "Well, I'm willing to accept the risk for those things as long as it helps with my body weight." But, you are talking about greater weight in people using the non-sugar sweeteners.

Jason: Right. In terms of long-term impact on body weight, there is not a lot of evidence. This is all coming from cohort studies, and cohort studies have caveats associated with them. But, what we see in those studies is it is either really not much of an positive impact, but we did see some increased risk. For example, there was an increased risk of incident obesity in one study. They looked at people at baseline without obesity using standard WHO cutoffs. Then they followed them up over time. They counted the number of people who transitioned over the obesity threshold, and they found that it was higher in those using non-sugar sweeteners. So there is some evidence, but I think we need additional evidence to be really sure about that in the other associations.

So Jason, you alluded to this earlier that there were differences in the health outcomes reported in randomized controlled trials versus observational studies. Can you explain why this might be?

Jason: Yes. So it is a bit nuanced and I think a lot of it has to do with the nature of the studies. To really understand this, we need to unpack that high-level evidence a bit. I think I'll start just by talking about what is maybe the elephant in the room and that is reverse causation because it has been frequently invoked as a reason for the associations observed between non-sugar sweeteners and body weight and disease outcomes. Basically, reverse causation suggests that those already at elevated risk of disease initiated or increased the use of non-sugar sweeteners because of their risk status, rather than non-sugar sweeteners leading to the increased risk in otherwise healthier low risk individuals. That would make sense in this case. However, researchers who conducted the individual studies that we included in the review were also well aware of the potential for both reverse causation and residual confounding. Most of them really went to great lengths to minimize the possible interference of these phenomenon and they adjusted extensively for confounding variables and all the lifestyle variables. Quite often, they adjusted for other dietary variables. They looked at body weight, they stratified, and they did sensitivity analysis where they would limit the analysis to individuals with normal body weight. They also removed from the analyses, in some cases, those at risk for disease at baseline. Many of them did a sensitivity analysis where they excluded the first several years of assessing the outcome, just to make sure that someone who wasn't already really at risk to develop a disease right away was not part of the analysis. You know, in some cases the effect was attenuated. But, for the most part, the associations were not affected. Certainly, that is the case for type 2 diabetes. So I think that reverse causation might have contributed, but, really the lengths that the study authors took to address it I calms us a bit in terms of whether or not We are worried about it.

It is very helpful to know that. You know, we've gone for years and years thinking that these things are safe, or at the worst have neutral effects. Now the studies are showing the negative effects. Partly, it is just because the science has marched ahead. There are many more studies now. People have been more careful with the design of the studies. More sweeteners have been studied. This seems like just kind of a natural progression of the scientific process.

Jason:  Yes, that is how it works. We continually add. There is still a lot to look at in terms of the differences. Another really important thing to remember is that in the RCTs, a variety of interventions were employed. A lot of the studies took people who were consuming a normal diet, and they just gave them, for example, a sugar-sweetened beverage, or non-sugar sweetened beverage. They wanted to look at what the effects of a sugar-sweetened beverage are. Very few actually looked at individuals who were habituated to sugar, mostly sugar-sweetened beverages. They then asked study participants to replace the sugar with non-sugar sweetener. When you look at just those small number of studies, the results really get attenuated for both body weight and for BMI. That is another reason why if you look at it that way, the results between the long-term and short-term tend to gravitate towards each other.

One last thing - I don't want to overdo it here, but it is important - there are likely big, big differences in terms of how non-sugar sweeteners are used in these highly experimental randomized controlled trial settings and cohort studies, which are really more like real world use. In a randomized controlled trial, you're instructed to do this, or that. Drink this, take that. You get quite a bit of support from the study team. You'll get counseling, follow up, etc. Everyone knows they are in a scientific study. Quite often, they actually know which arm they are in. Whereas in the cohort study, in the real world, people use non-sugar sweeteners in a variety of ways. Sometimes they do it as a conscious replacement for sugars. But quite often, they just consume beverages containing non-sugar sweeteners or foods containing non-sugar sweeteners because they have a diet label on them, and they just perceive that those types of products to be healthy. Sometimes they use them as a way of having something sweeter or something that maybe they shouldn't have later on in the day. It is much more complex in the real world and obviously the real world is how these things are used. So how sweeteners are used also can contribute to these differences between what we see in highly experimental randomized controlled trials and the real world.

- [Kelly] So how do these non-sugar sweeteners cause these negative health effects?

- [Jason] We don't know for sure. Let me just say that upfront. But we have ideas and the scientific community has ideas. A lot of mechanisms have been put forth to explain how this might be happening. A lot of them are actually linked to the expression of sweet taste receptors. They are expressed in the mouth, obviously, that is how we perceive things to be sweet. But they are also expressed elsewhere in glucose sensing cells, such as the gastrointestinal tract and pancreas. So there are a number of different ways that this might work. There could be effects on taste perception, sweet taste preference, a threshold of sweet taste sensitivity, and eating behavior as it impacts on hunger or appetite. There could be other neural responses. There is this whole discussion about the hedonic response to any sweet taste. Also, there might be release of metabolic hormones, and other biological molecules, in response to non-sugar sweetener intake. Then, of course, There is a lot of buzz around potential alterations to the gut microbiome, which is a really interesting area. But There is a lot of understanding still to be gained there. Also, as noted, in terms of potential mechanism, it could be that the behavioral component we just spoke about, in terms of how people actually use non-sugar sweeteners in the real world, could also contribute to the association between non-sugar sweetener use, and body weight, and disease outcomes.

A vast number of effects happen once these things get into the body. So Francesco, let me come back to you. What is WHO recommending? I know some recommendations that have been made are conditional. What does this mean?

Francesco: So the recommendation reads that the WHO suggests that non-sugar sweeteners not be used as a means of achieving weight control, or reducing the risk of non-communicable diseases. It is a very simple one. It is basically saying that you're using the sweeteners, but they are not going to help you in weight control, or reducing the risk of that related non-communicable disease. So Kelly, as you said earlier, would I take the risk potentially associated with non-sugar sweeteners if I knew that this would benefit my weight? But in this case, what we are saying is, "Well, look, it is not going to benefit your weight control." We are leaving it there, because the purpose of this review was, particularly, to look at weight control. We were not looking at other aspects of safety - which is actually the task of other regulatory/advisory bodies, although we had to consider in the recommendation when we called the balance of benefits and harm. So here, the recommendation was clearly to say, "Well, you shouldn't use it, because there is no demonstrated benefit, and there might be some harm."

Now, WHO can make two types of recommendations. Recommendations can be strong or conditional. The decision on whether to go for the stronger condition is based on a number of factors - certainty in the supporting scientific evidence, and the balance of desirable and undesirable consequences. A strong recommendation is the recommendation for which WHO gathering group is confident that the desirable consequences of implementing the recommendation outweighs the undesirable consequences. In most situations, this would be something that government can take on immediately and use in their policymaking. A conditional recommendation is a situation where the WHO guide group is less certain about that balance between the desirable and undesirable consequences. Therefore, we are basically saying, you need to consider the context, and then decide what to do with this particular recommendation. So, in this case, why did we go for conditional? There is an element related to the balance and the evidence that Jason described earlier on. There is also an issue about short term versus longer-term consumption. We have been trying to explain why not using does not create a problem. The action also depends on the context of use of this particular product. For example, the levels of consumption in different age groups in the population. So, in a sense, our understanding of the issue, is still not complete. We believe that we need to have more science on the topic. We decided to take a bit of a conservative approach. That is why we end up saying conditional, which means we still recommend that people not use non-sugar sweeteners. But in terms of making use with this recommendation, we would like governments to also do their own assessment on how to translate this into policy practice.

So Francesco, on one hand, we have sugar being a bad actor and now the replacements for sugars can be bad actors. So how does this get balanced out? Should people go back to sugar? Should they just get used to things being less sweet? How does this work?

Francesco: So definitely people should not go back to sugars because we know that consumption of free sugars has been linked to unhealthy weight gain, type 2 diabetes, cardiovascular disease, and dental caries. We definitely maintain the recommendation that we should limit free sugar intake. But unfortunately, non-sugar sweeteners are not producing a good benefit if we replace them with sugar. What they are saying is that both free sugars and non-sugar sweeteners should be limited. So yes indeed we would need to adjust our own taste to consuming products which are less sweet. We should also ask the producers to reduce the sweetness in their product.

So Jason, do you have some thoughts you'd like to share about this?

Jason: Yes. Again, from a scientific evidence standpoint, it is interesting. If you look at the literature, and you look at the studies, and we have lots of studies now, and a lot of systematic reviews, and umbrella reviews that really tried to make sense of all of this. But if you look at some of the impacts, associations between sugar intake, and diet-related noncommunicable diseases, especially type 2 diabetes, and you look at the actual magnitude of associations, the increased risk, they are really in line with what they are for non-sugar sweeteners. In fact, some recent modeling published in 2022, modeling in the prospective cohort studies, shows that when you replace sugar with non-sugar sweetener, you basically end up with a no result. Which means that non-sugar sweeteners, at least in terms of type 2 diabetes, are just as bad for you as sugar-sweetened beverages. These studies are all looking at beverages. It is interesting that we have to keep in mind that they may both be bad actors as you indicated, Kelly.

What an amazing picture. Francesco, so do you think that non-sugar sweeteners should not be used as a harm reduction mechanism to help people reduce their sugar intake?

Francesco: Yes, that is what our recommendation basically says. We are encouraging individuals, but also government, to think of other ways to reduce sugar intake that does not require the use of sweeteners as a replacement. There are ways to do that. I mean, certainly, there are unsweetened variants of the same food or drink. There are alternatives in diet patterns. You don't necessarily have to have a dessert at every meal. You can have fruit. We know that the fruit sugars do not have the same metabolic effect as free sugars. We know that, for example, certain countries, like in the UK have given options to companies to use sweeteners instead, to avoid the sugar levy. Probably, we would ask those countries to have an assessment of what has happened and see whether that policy is still a useful one, or if it should be revised.

So Jason, I'd like to ask you about diabetes. Does the recommendations apply to people with diabetes, and can people with diabetes use these non-sugar sweeteners?

Jason: I'll tell you, that is a question we are getting a lot of. Our guidance really is for preventing the development of disease, and not for treating, or managing existing disease, including diabetes. In terms of the process, making recommendations for preventing disease is very different than making recommendations for managing disease. Different scientific evidence needs to be reviewed. In the case of diabetes, some of the evidence is overlapping. But we really do need to look at a different body of evidence and a different assessment of potential risks and benefits needs to be made. This is all in the context of a larger plan of treatment, which may also include medication, and other lifestyle changes. Therefore, managing disease requires greater input from clinicians. Something else to remember is that individuals without diabetes do have the option to include some sugar in the diet when something sweet is desired. But for many with diabetes, this isn't really an option. With that said, individuals with diabetes can certainly manage their disease without the use of non-sugar sweeteners. However, such decisions really should be made on an individual basis, and only in consultation with one's healthcare provider.

So Jason, let me ask you a question about Stevia in particular. So there are some thinking that because it is natural, unlike the artificial sweeteners, it is somehow different. So why doesn't the recommendation make distinctions between different non-sugar sweeteners?

Jason: That is a great question. Although all non-sugar sweeteners have unique chemical structures, and consequently may differ in their sweetness intensity, organoleptic properties, and routes of processing by the body, we don't make a distinction in our guidance between individual sweeteners or between so-called natural sweeteners, like Stevia, and artificial sweeteners. This is because all sweeteners, including sugar, use the same biological pathway when it comes to how we perceive them as sweet tasting, so the sweet taste receptor I mentioned earlier. And, consequently, how they might impact weight and risk of disease. Also relevant is the possibility that we discussed before, which is that people may use these in ways that promote weight gain and disease, irrespective of what type of non-sugar sweeteners being used. We feel that the evidence for a class effect is sufficient to include them together in our recommendation.

That is very helpful to know. So Francesco, some organizations, for example, the Food and Drug Administration in the US, have declared over the years that these non-sugar sweeteners are safe for use. If those organizations feel they are safe, then why is WHO recommending that they not be?

Francesco: In a sense, it is a different issue. Before any of these compounds are used in food, it has to go through this safety assessment. You mentioned the Food and Drug Administration. FAO and WHO are managing a joint expert committee on food additives that is providing advice to the Codex Alimentarius. And all these bodies, basically what they are saying is, they look at the toxicology of the products and they use animal studies. In some cases, they look at human studies. But they are basically looking at acceptable daily intakes that provide usually short term impacts. We are also encouraging these bodies to consider longer-term epidemiological studies to look at other kinds of effects. For example, at the moment there is a big debate going on because both the International Agency for Research on Cancer, and the JECFA, are looking at the safety of aspartame and considering, for example, certain longer term epidemiological human studies. These bodies are talking about certain aspects of safety and looking at the very high levels of intake. Just to give you an example, at the moment the acceptable daily intake for aspartame is about 40 milligrams per kilogram per day, which is 2.8 grams for an average individual. That is about what you would get from 14 cans of a commonly consumed drink. That is a lot. We are saying maybe that is something that can be moderated. So these bodies talk about safe or maximal levels of intake of individual sweeteners. Here, in our recommendation, we are saying this practice of replacing sweeteners with sugars is not going to lead you to improved health gains, but you're getting into an area of risk that even if it is within the agreed safety level, is something that you may want to avoid.

That is helpful context. So, what are the policy implications of all this?

Francesco: Some countries are already considering giving a warning on the content of non-sugar sweeteners in products. For example, what you have in Mexico. Some countries might decide to give the same warning if it is something that should be at least not encouraged. So that could be a way to do it. Other countries, while using nutrient profiling system, for example, for front of the pack labeling, or for marketing regulation, may decide to include sweeteners in the list of food that should be avoided. That is also happening, again, in South American countries. From our point of view, I think we would really like to give the message that the sweetness of food should be reduced. The same way we are having a dialogue with the food industry about reduction of the sugar content of food, particularly in foods that are intended for young children. We would really like to give a message that we should reduce the content of sweeteners. That is possible. And not relying entirely on sweeteners as an alternative for the reduction of sweetness or, reduction of calories, but really looking at a change in the strategies in peoples' daily diets.

Thank you, I appreciate that. You know to the extent one person can be instructed in this, 11 or 12 years ago, or so, I stopped drinking diet beverages because of the very concerns we were talking about today. I just switched over to tea with no sweetener in it at all. I'm completely accustomed to that now and I find it very enjoyable. I also find the things that I used to drink to be completely oversweet now. So people can get calibrated at different levels of sweetness, can't they?

Francesco: Absolutely. In a sense, this is the same discussion we've had with salt. I mean our capacity to adapt is there and it happens relatively quickly. People can enjoy foods without having that enormous level of sweetness. As we know, sometimes the excess presence of other salts, or sugar, or sweeteners, is some have a way to cover the lack of good taste from the other ingredients. So good foods and drinks can certainly happen without the unnecessary addition of this compound.

Bios

Jason Montez is a Scientist in the Department of Nutrition and Food Safety at the World Health Organization (WHO) in Geneva, where he works on the development, dissemination and implementation of nutrition guidance. Prior to joining WHO, Dr Montez was a consultant to WHO and other international organizations and co-founder of a biotechnology start-up. He received a PhD in Biomedical Sciences from The Rockefeller University and MPH from New York University, both located in New York, USA. 

Francesco Branca is the Director of the Department of Nutrition and Food Safety at the World Health Organization (WHO), Geneva. He graduated in Medicine and Surgery and specialized in Diabetology and Metabolic Diseases at the Università Cattolica del Sacro Cuore, Roma. He obtained a PhD in Nutrition at Aberdeen University. He was a senior scientist at the Italian Food and Nutrition Research Institute (INRAN). He was President of the Federation of the European Nutrition Societies from 2003 to 2007.

Rios-Leyvraz, Magali; Montez, J. “Health Effects of the Use of Non-Sugar Sweeteners: Systematic Review and Meta-analysis,” World Health Organization. https://www.who.int/publications/i/item/9789240046429

WHO guideline on use of non-sugar sweeteners https://www.who.int/publications/i/item/9789240073616

No one actually wants to waste food, right? And yet, a new national study on food waste at home shows we've become more wasteful recently. US families self-reported a 280% increase in discarded food between early 2021 and early 2022. What's more, households tossed out more food during weeks they ate out. Today, we will explore results from a national tracking study published in the Journal of the Agricultural and Applied Economics Association. Our guests to help us learn more about this topic are economist Kathryn Bender. Katherine studies consumer behavior and food waste at the University of Delaware. We also have Brian Roe, who is an agricultural economist from the Ohio State University. Brian's research focuses on food waste and consumer economics.

Interview Summary

Norbert: Kathryn, let's begin with the big-picture question. Why should we care what people do with their food once they have purchased it?

Kathryn: Great question. So we know that food waste has huge environmental and economic impacts. Thirty percent of food that's produced for human consumption ends up going uneaten. When that food is wasted, we know that all the resources associated with producing it, such as land and water, are also wasted. And those resources themselves have their own cost. Decomposing food emits methane, which is a greenhouse gas that is 25 times more potent than carbon dioxide. There's also emissions from the transportation and distribution of that food from farmer to consumer. I don't think that most people set out to waste food, nor do they feel really good about doing it. In addition, households fall at the end of the supply chain, so consequences from upstream decisions made by manufacturers and distributors, may fall on the households themselves. For example, if there's milk that has not been kept cold along the supply chain, the consumer may end up throwing it away because it starts smelling or tasting off sooner than it really should. Another example is dates placed on food packages. Producers have more information about the quality and the safety of their product than consumers do. Many individuals use those dates on the package to determine when they should throw something away. If producers are conservative in this labeling, or if that language is unclear, consumers may the discard perfectly good food based on the date alone. If we can identify policies aimed at producers to effectively communicate information about the product to the consumer, as well as methods such as strict adherence to cold chain processes, we could help reduce food waste at the household level. I think, overall, we want to develop the tools necessary to set consumers up for success in minimizing their food waste.

Brenna: Kathryn, thanks so much, for laying out all the reasons why we should care about this topic. We so appreciate the work you and Brian are doing to help us better understand it. So with that, Brian, can I turn to you? Would you mind telling our listeners about the national tracking survey, what you all are hoping to learn, and some of the findings you have so far?

Brian: Sure. The United States set a national food waste reduction goal back in 2015. Three different administrations from vastly different political viewpoints have all kind of gotten behind that, and really want to see that goal met. And yet, we don't have great data to track how our food waste habits are changing over time. Particularly for consumers. Some other sources of data suggest consumers are the source for 40% to 50% of wasted food that we see. We really wanted to try to start to develop some data in this area. Hence, we set up a national tracking survey. We used an online survey approach, which has some known issues with it. It tends to under report the absolute level. But we're asking the same questions over and over again - we now have seven waves of data collection between 2021 and 2023. We have a consistently asked set of questions that we can use to understand patterns and trends that might be emerging across the country among consumers as they're wasting food in their households, and this helps us get perhaps a bit more level with the United Kingdom. They have got this great survey data series that they use with consumers to track food waste going back to, I believe it's the early 2000 and teens. We really hope to learn some things from our findings, and we are seeing some interesting patterns emerge.

Brenna: It's great that you are starting a tracking survey. Most of us on the podcast work on food waste, and we know that it can get literally very messy trying to measure it in other ways. There are limitations in all the ways measuring. I appreciate the work that you all are doing. So Brian, you started collecting data as Covid restrictions were lifting. Why did you choose this time to start the tracking survey?

Brian: That's just kind of when we got organized. My early research portfolio was very focused on going into homes with apps and things like that to get a very granular view of food waste. But then, it kind of really struck me that we need to have data on consumers, even if it's not perfect. We need to ask those questions consistently. That's when we were able to muster our resources and begin to collect the tracking data. With the help of the National Science Foundation, we've been able to solidify that tracking approach and now we have a funding stream that will allow us to continue this for at least five years. That's very helpful.

Brenna: Perfect, thanks for clarifying that. Kathryn, if we can come back to you. According to the Bureau of Labor Statistics, food-at-home prices rose 8.6% over the period of your study. I'm curious why consumers were actually wasting more food as food prices are going up.

Kathryn: I think it really comes down to how consumers are managing their food stock at home. Two things that we noted from this study was that over that year we analyzed, food that was bought in bulk and was subsequently thrown away doubled. So increased food prices may have prompted households to purchase more food in bulk. We also found in a previous study that households really increased their cold storage capacity by buying refrigerators and freezers during lockdown. I think that the increase in cold storage capacity and purchasing more bulk food adds kind of this new dimension to food stock management that households may not have adjusted to yet. We also saw that food waste attributed to unplanned dining out events increased. This makes sense as we were able to go out more. Restaurants weren't closed down, and didn't have as many restrictions. We were able to go out more, and we had more food that was wasted because we planned on eating at home. But we took advantage of an opportunity instead to go out with friends or something like that. So as people go back to their more hectic lifestyles, I think that just food management becomes a little bit more difficult. We need to make sure that we provide support and educational campaigns to help households manage their food at home. With higher prices being at the forefront of a lot of people's minds right now, I think that highlighting food waste reduction is a great method to save money.

Norbert: Kathryn, that's really interesting, and it makes me think of a couple of studies that I've done with Brenna and our colleague Linlin, and some other work that I've done, where we did see a relationship between the price of food and the predicted waste. What we saw was that there was a negative relationship. So it's interesting to hear this example of increases in the price leading to or at least associated with this increase in food waste. But, I think what's really fascinating is it may be a reduction in the per-unit cost because people were buying in larger quantities. That's a really fascinating thing. One of the things that we were looking at right when Covid started, people were reducing their food away from home significantly as we weren't allowed to go out and we weren't ordering out. So, it's interesting to see this kind of change. I look forward to seeing what subsequent rounds of the survey will show about what happens with food waste and hopefully as price inflation goes down. Brian, I want to turn back to you and ask: a 280% year over year increase in food waste is really high. Do you expect that food waste will continue to increase at this rate?

Brian: Yeah, we've actually got some data in on that now. So the published data shows that 280% increase between the beginning of 2021 and the beginning of 2022. That was right after the Omicron Christmas, if we remember that, and vaccines were coming on board. What we've shown now is that behavior has retracted a bit. We're down to now merely a 200% increase from that February '21 wave to the February '23 wave two years later. So it came down from that 280% peak to a doubling of food waste between early Covid days to back-to-reality-here for many people in February 2023. I think part of that is what Kathryn talked about before. That we had probably a big purge, I would guess that spring cleaning after Omicron, right? People probably were sitting on a fair amount of money in terms of finances. Restaurants were really fully reopening. They went out unexpectedly, spur of the moment, ate out during their reporting week and that caused them to report more waste. They probably looked through their cupboards and saw all this bulk stuff they might have bought during Covid and said spring cleaning time. Maybe we need to get rid of some of that stuff as the date labels grew longer and longer in the past. Once they got that out of their system, and this is the thing, we don't know what pre-Covid was, but maybe this is kind of a return to pre-Covid level. We'll never know that because we can't reproduce data that we don't have to pre-Covid days, but perhaps that February 2021 was kind of that peak studying our fridge over and over again trying to find every last leftover and shows a very low level. The data that we're getting here in February of 2023 is kind of a return to normal. That's what's happened in the United Kingdom as well, where they do have a longer tracking survey. They found right after the onset of Covid, a pretty big drop in reported food waste; about by half in terms of their metric. And then, a kind of a slow but steady march back towards pre-Covid numbers is what they found right about the end of 2022. So a little bit different in the pattern, but not dissimilar in terms of overall trends.

Norbert: Your explanation makes really good sense, and so thanks for explaining that. I'm hopeful that this is going back to a lower rate of waste. It will be important to see how subsequent surveys tell us what happens with food waste as we move forward, and hopefully without a pandemic in between.

Brian: And perhaps new approaches to finding other sources of data so that can maybe validate our hypotheses here about what's going on with these trends, would also be very important. It's nice to have tracking survey data, but it's correlative, right? We're not doing any randomized experiments here to be able to understand the true links and causality. So as always, we need more research to validate this to help us understand how we can jump in, intervene and help the US meet its long-term food waste reduction goals.

Bios

Kathryn E. Bender, Ph.D. is an Assistant Professor in the Department of Economics at the University of Delaware. Her research in environmental and experimental economics focuses on consumer behavior and food waste. She has a Ph.D. in Agricultural, Environmental, and Development Economics from The Ohio State University.

Brian Roe is the Van Buren Professor in the Department of Agricultural, Environmental and Development Economics at Ohio State University. Roe attended the University of Wisconsin – Madison where he received a bachelor’s degree in Agricultural Economics. Roe went on to receive a Ph.D. in Agricultural and Resource Economics at the University of Maryland. Prior to his employment at Ohio State, Roe worked on policy issues surrounding food safety and health information disclosure as a Staff Fellow at the US Food and Drug Administration in Washington, DC. 

Today we speak with an expert on sugar and things meant to replace it. The stakes are high. Very high. Sugar consumption in the population is astronomical and so is the use of sugar replacements. Knowing the impacts of both could help experts provide dietary guidance and help consumers make decisions. Dr. Robert Lustig is Professor Emeritus of Pediatrics in the Division of Endocrinology at the University of California, San Francisco. He specializes on the regulation of energy balance by the central nervous system; body weight regulation, appetite, metabolism, and is very well known for his work on sugar and their substitutes and on policies aimed at improving the diet of the population. A YouTube video on the effects of consuming sugar called “Sugar: The Bitter Truth,” has now been viewed 24 million times.

Interview Summary

URL for “The Bitter Truth video (https://youtu.be/dBnniua6-oM)

Let's start out with this - so the big hope is that sugar replacements, artificial sweeteners, non-nutritive sweeteners, all known as different things, replace sugar and that people can enjoy sweet taste without the calories. But, of course, the picture is way more complicated. Being an endocrinologist, you are in a good position to explain what happens when the sweeteners enter the body. I'd like to get to that in just a moment, but let's lead off with another question. Why is it so important for people to consume less sugar?

First, let's talk about what sugar is. The food industry tells you that sugar is just empty calories. I wish that were true. If that were true, then you could basically spend your discretionary calories on sugar with no problem. But it's not true. There are two molecules in dietary sugar: the sucrose or the high fructose corn syrup or honey maple syrup agave. They are all basically the same. One molecule of something called glucose, one molecule of something called fructose. Glucose is the energy of life. Glucose is metabolizable by every cell on the planet. Glucose is so important that if you don't consume it, your body makes it. The liver will take fats and turn it into glucose. It will take amino acids and turn it into glucose process called gluconeogenesis. Glucose actually makes your cells work better. It makes your mitochondria function better, the mitochondria being the little energy burning factories inside each of your cells. Glucose, for lack of a better word, we can call good. Fructose, on the other hand, it is completely different, is metabolized completely differently inside the body and inside the liver. What fructose does is it inhibits mitochondrial function. It actually inhibits three separate enzymes necessary for mitochondria to do their job. So, fructose inhibits energy generation. Now, the food industry will tell you fructose is four calories per gram. Fructose is ready energy. That is why they put high fructose corn syrup in the sports drinks, for example. Well, turns out, that fructose may be ready energy for a bomb calorimeter, but it is not ready energy for your mitochondria. You don't burn in a bomb calorimeter (a laboratory instrument), you burn via your mitochondria. It turns out, mitochondria are actually poisoned by fructose. So in fact, fructose is a chronic, dose-dependent mitochondrial toxin and this is why we have to eat less of it. But the problem is the food industry keeps putting it in anyway despite the fact that it is killing us.

How much more of it are people consuming than what you might suggest?

The American Heart Association years ago came up with a upper limit per day of about 25 grams, which would be about six teaspoons per day. I was actually part of that group that came up with that and I stick to it because that's what the data show. We are currently consuming 94 grams. We are consuming almost quadruple the amount that is the upper limit. Now, the notion that something could have empty calories but still be bad for you is not a crazy one. We have two things in our diet that we know are calories but are clearly toxic to us. One is alcohol. Alcohol, seven calories per gram, but alcohol is a poison. And then also trans fats. Trans fats are nine calories per gram, but trans fats are a poison. So just because something has calories doesn't have anything to do with its metabolic impact.

Where are people getting all the sugar from? I'm assuming it's not from their sugar bowl.

Exactly. It is not the sugar they add. It is the sugar the food industry adds. Now, where is it? Well, the obvious source is soft drinks. That's number one by far and away. I mean soft drinks are basically, you know, the devil incarnate. Several municipalities have actually figured that out, and it's one of the reasons we have soda taxes because it's actually directed at the problem. A lot of it is in other things that we identify as sweet: candy, cakes, ice cream. A lot of it is in other things like breakfast, cereal, yogurt, even cured meats. It is in a whole host of other things. When you add it all up, 65% of the sugar you consume is in ultra-processed foods. It is not in regular food. It is not in sugar you added to your own food. It is in ultra-processed foods. An ultra-processed food is the vehicle by which the payload, that is that fructose, is doing its damage.

Thanks for that background. We're really here to talk about the artificial sweeteners but it is irresistible talking to you about sugar in general because you described the whole picture in such a compelling way. So thank you for that. So, onto the artificial sweeteners. What are the main ones in the food supply?

Well, there are a whole bunch. The most common ones that the food industry uses the most, obviously aspartame, which is Equal. And also sucralose, which is Splenda. But there are others now out on the market: Neotame, there's Acesulfame-K, there's monk fruit, there's Stevia, and all the Steviol glycoside derivatives. There's now Allulose, and there's Tagatose. There's a whole host of different sweeteners that are considered "non-nutritive” meaning they don't have calories.

These things show up in ways that people don't necessarily recognize. I mean Diet Coke, Diet Pepsi, those sort of things, it's obvious they're artificially sweetened. But these things are showing up in a lot of places, aren't they?

Indeed. The food industry now understands that sugar is a problem and people have been calling for less sugar but what they're not calling for is less sweet. And so the industry has a job. It has to deal with that dichotomy.

I know understanding their impacts is complicated by the fact that there are a lot of these things and they're all chemically different from one another. I'm imagining they have different metabolic effects. What happens when these things get into the body?

Right, and that is the issue. It has nothing to do with calories. People think calories are the issue. This has nothing to do with calories. That's one of the reasons, Kelly, that I'm committed to one concept: kill the calorie. Kill the calorie as a unit of measure. It was never appropriate. It was actually subterfuge, and it was actually promoted and promulgated by the food industry because if it is about calories, they can assuage their culpability for what they've done to our food supply. This has nothing to do with calories. This has to do with metabolic health.

Now, the World Economic Forum just published a white paper called the, "True Purpose of Nutrition," and it comes down to two words: metabolic health. That is what is going on inside the cell and that's where the artificial sweeteners do their damage, inside the cell. That's what we have to talk about. There are several places in the body where artificial sweeteners can do damage that have absolutely nothing to do with calories. The first, you put something sweet on your tongue. Message goes tongue to brain, "Sugar's coming." Brain sends a message to the pancreas, "Sugar's coming, release the insulin." Then the sugar never comes because it was a diet sweetener. What does the pancreas do? It turns out it releases the insulin anyway even though it had no calories, even though it wasn't sugar, just because of the sweet taste. So this is known as the cephalic phase of insulin secretion. That insulin is driving energy storage into fat, number one, and it's also driving cell proliferation in your coronary arteries, cell proliferation in your breast tissue, in other words, cardiovascular disease and cancer and ultimately leading to burnout of your pancreas, and now you've got diabetes too. Even though these artificial sweeteners have no calories, they still generate an insulin response, which is still problematic from a metabolic standpoint.

So because of the sweet taste and the body's response to that, I'm assuming what you're saying would be true to all of sweeteners?

Exactly. All of them do that. The next step is the artificial sweetener goes down your gullet, goes into your intestine, and the intestine has these bacteria in it called the microbiome. Most people have now heard of that. Different bacteria lead to different effects in the intestine. But think of your intestine - I mean it's a sewer. It has a whole lot of S-H-you-know-what in there. The goal of the intestine is to keep the S-H-you-know-what IN the lumen of the intestine and not allow it into the bloodstream. It uses three barriers. It has a physical barrier called the mucin layer. It has a biochemical barrier known as tight junctions or zonulins. It also has an immunological barrier called Th17 cells. Those three barriers have to work right to keep the junk out of your bloodstream because if the junk gets into your bloodstream, you now have systemic inflammation, which drives insulin resistance and drives chronic metabolic disease as well. So keeping your intestine in tiptop shape is really important. Well, it turns out those diet sweeteners alter the microbiome. Some of those bacteria like those sweeteners and utilize them to make toxic byproducts, which damage the mucin layer, damage that biochemical tight junction barrier and allow for things to seep through. This is a process called leaky gut. For reasons that are still unclear, sugar tends to deplete those Th17 cells, rendering the immunologic barrier devoid of function. The sum total of which means all the you-know-what in your intestine ends up in your bloodstream, goes to your liver, generates insulin resistance, and you are off to the chronic metabolic disease races as well, from diet sweeteners having nothing to do with calories.

What an amazing picture your painting of these things.

We’ve got one more mechanism. At the fat cell, now this I really don't understand and it's early data but seems to be consistent. Turns out adipocytes, fat cells, have receptors for diet sweeteners. Don't ask me why. I don't know why. But it turns out, diet sweeteners can act like insulin right at the fat cell to increase energy deposition into the fat cell. Growing those fat cells all by themselves, due to the diet sweetener rather than due to insulin. Now how dumb is that? As a result, there are a lot of different ways diet sweeteners might end up causing problems as well, having nothing to do with calories, having nothing to do with fructose. There was a paper that came out in the European Journal of Clinical Nutrition. It was a meta-analysis of sugar and also of diet sweeteners in terms of diabetes and heart disease. What I can say in one sentence to sum up what this paper showed is that the toxicity of one Coca-Cola equals the toxicity of two diet Coca-Colas. Half as bad. That doesn't mean good. It means half as bad.

Boy, I mean, any one of the three major pathways to harm would be of concern. If you add them all together, it is a pretty striking picture, isn't it? I imagine, even if somebody knew about this, they might say, well, you know, I'm willing to accept those risks. I mean, even though you are making them sound substantial, but I'm willing to accept those risks if these products help me control my weight. Do they?

Well, they don't. That's part of the problem. There is not one study, not one study in the entire world's literature, that shows that switching from sugared beverages to diet beverages actually controls weight. The reason is because even though the diet sweeteners don't release as much insulin now, when you drink the diet sweetener, the pancreas releases it later. That's actually been shown in several studies now. You get a delayed insulin response, so that the 24-hour insulin burden is the same whether you consume the sugar or the diet sweetener.

Let's talk about safety for a minute. What about sort of the typical toxicology concerns that people have had for years about these substances, irrespective of what they're doing to the pancreas and to the other, the microbiome, et cetera? What about the just kind of pure safety of them?

Right, so the one that has generated the most heat, not too much light, unfortunately, is aspartame, NutraSweet. It turns out that aspartame has a very long and checkered history. Did you know that aspartame was made by Searle, G.D. Searle? And, do you know who the CEO of G.D. Searle was at the time that aspartame was approved by the FDA?

I do not.

His name was Donald Rumsfeld.

An interesting character in history.

Indeed, wouldn't you think? It turns out that G.D. Searle actually buried most of the toxicology of aspartame in order to get it approved. It is a long complicated and involved story, which we don't have time for. I'm not even privy to most of the details on that. The bottom line was it ultimately did get approved despite the fact that there was a significant amount of concern about toxicology of this compound. Those questions still remain today. That is one. Another one that is a big issue is sucralose. Sucralose is also called Splenda. Sucralose is a chlorinated poly-fructose and it's extremely sweet, no question about that. It seems to have some GI side effects that a lot of people don't like. It also has now been associated with cancer. And most recently, the one that's gotten the most attention and almost assuredly, Kelly, the reason you called me is the paper that came out about three weeks ago in science about erythritol. So erythritol is a sugar alcohol, and now the meta-analysis of erythritol consumption suggests that it may in fact contribute to heart disease. Now, is that true? Meta-analysis are complicated. People think meta-analysis are the piece de resistance, the highest bar of medical information and analysis. I have four words for meta-analysis: garbage in, garbage out. Meta-analyses are only as good as the studies that they base the data on. If those studies were done by the food industry, which almost all of these are, because that's who stands to benefit from them. These are almost never NIH studies. These are almost always food industry studies, as you know, the odds are 7.61 times more likely to find in favor of the compound of interest. So all of these are, shall we say, biased. All of these are tainted, and meta-analyses are basically a conglomeration of tainted studies. So what do you expect the result to be?

Thanks for that background. I'm imagining also regarding toxicology and safety, that some of the newer sweeteners like Splenda for example, sucralose, there hasn't been enough years of use to pick up long-term chronic effects.

Well certainly, if you're using cardiovascular or cancer events, you're absolutely right. A lot of these events, you know, take a long time to manifest themselves. Sometimes, a generation or even two generations for that matter, especially for heart disease and cancer. The 15-year-old is drinking 10 diet sodas. When do you expect the heart attack to show up? You know, it's complicated.

So we use biomarkers to try to answer these questions, but then the biomarker has to actually be a good proxy for those events and often they're not. Let me give you an example, LDL. Everybody thought LDL was the bad guy. Turns out triglycerides are the way worse guy. LDL has a hazard risk ratio for heart disease of 1.3. Triglycerides have a hazard risk ratio of 1.8. Triglycerides are 50% more important in determining heart disease than LDL is, but we use LDL as the biomarker because it's more stable. So you have to use the right biomarker and you have to interpret it properly and it actually has to mean something and it has to change relatively acutely. All of which are problematic for all of these biomarkers. It's hard. It's hard to do these kinds of analyses. Having said that, my group, a scientific advisory team that I convened to help an offshore ultra-processed food company improve the health of their products. We've published this just last month in Frontiers in Nutrition. The company is called Kuwaiti Danish Dairy Company, or KDD. The title of the paper is, "The Metabolic Matrix: Re-Engineering Ultra-processed Foods to Protect the Liver, Feed the Gut, and Support the Brain." We did a deep dive on diet sweeteners. We looked at all of these diet sweeteners and their proxies, all the biomarkers. The one that actually popped out that looked to be the most beneficial, at least acutely, is a new one that we're actually kind of interested in and is picking up speed and it's called allulose. Allulose currently is 12 times the cost of sugar, but that's coming down. It turns out allulose lowers LDL and raises HDL. So it may have a better cardiovascular profile, but again, all the caveats that we mentioned before.

That's very interesting. So given your interest in pediatrics, what about children using these sweeteners?

I am totally against children using sugar because they get fatty liver disease and Type 2 diabetes, and I am totally against them using diet sweeteners because, number one, we don't know what they're going to do. Number two, they don't actually lead to weight loss. That data we do have. So as far as I'm concerned, we really only have one option and that is de-sweeten our lives. We have to de-sweeten the food.

Perfect lead in to the next question I was going to ask. So do you think it is possible for people to become accustomed to less sweetness? I mean, let's say the food industry is required to gradually reduce sugar and sweetness from the sweeteners. What do you think would happen?

Absolutely. It is not only possible, it is eminently doable. And I know why and we have the data for why that is. So there is a very smart lady, neuroscientist at the University of Michigan by the name of Monica Dus, who has done all this work in fruit flies of all places. She has shown the desensitization of the tongue to sugar has to do with changes in receptors and changes in specific substrates in the taste buds of the tongue. When you stop the sugar availability, it takes three weeks for those receptors to increase and repopulate, and for those problematic substrates to go away. You can actually retrain your tongue in three weeks to be much more sensitive to the sugar that is in the food naturally. After a three-week abstinence period or a reduction or a weaning period, a blueberry will taste like a sugar bomb in your mouth. So we know this can happen and we actually have proven this for salt previously. The UK, as you know Kelly, back in 2003, the Blair government convened all the food industry concerns in Great Britain. So Marks & Spencer, and Weight Rose, and Tesco, et cetera, all around the big table, didn't let media in, and basically said to every single food industry concerned in Great Britain, "Look, we have a hypertension and stroke problem and it's because of the salt content of the food and we are going to play referee here in the government. And each of you is going to reduce the salt content of your food by 10% per year over a three-year period so that you'll reduce your salt by 30% at the end of this and everyone's going to play together, so that there's no competitive disadvantage and most importantly, we're not going to tell anybody." That's what they did. Sure enough, in 2011, a paper appeared in Burge Medical Journal, demonstrating a 40% reduction in hypertension and stroke because of the public health effort that the Blair government made in terms of reducing the amount of salt in processed food. We can do the same with sugar today.

The salt example is a good one because I think many people have sort of experienced this in their day-to-day lives, even in the United States, where industry hasn't done exactly what's happening in Britain. People have tried to reduce salt in their diet, add less salt, and buy products with less salt. And then sometimes they'll go back and consume something that they had before and find it extremely salty, even unpleasantly salty. It's interesting to hear on the sugar front that that same experience might be possible and that there's a biological reason for it. It is not just that you psychologically get accustomed to different levels of sugar, in this case, but there's a biological change occurring that might help keep that going.

Absolutely. You can change people's behavior by changing their biochemistry. This is how I got into this field by using a drug that suppressed insulin and getting kids who were 400 pounds due to their brain tumor to actually lose weight and start exercising because we got their insulin down. You can fix the biochemistry and the behavior will follow suit. The food industry could do that and we wouldn't even notice.

So I'm guessing I know the answer to this question before I even ask it, but let's go ahead. Would you suggest the food industry be mandated to make gradual reductions in sugar, just like you mentioned with salt in the UK?

Absolutely, I'm working toward that. The only thing that I say is we should not tell anybody.

So it would be sort of a stealth move then. You would not necessarily have to make a big deal of it to the public, because they might assume there's going to be a change in the desirability and the pleasure of the products when that's not necessarily the case.

As soon as you do something to their food, someone's going to scream, "Nanny state!" This is not nanny state. Ultimately, this is a public health problem. We have to deal with it with a public health solution. You know, that means changing things. If the amount of sugar in our food supply went down, say by 3% every six months down, so that we were able to cut our sugar consumption by 25%, which would be the same basically as what a tax would do. We would save so many billions of dollars in healthcare costs, and we would increase productivity so much. We actually published a paper, a microsimulation analysis in BMJ years ago where we quantified the savings to government, to insurers, to the public. If we actually got sugar down and, you know, actually listened to what the USDA told us, it would be amazing. There is data, there's a pathway forward, there's precedent for doing it. I absolutely think that is where we need to go.

Rob, you're making me feel very smart at the moment, because I figured this was going to be a podcast filled with information and helpful bits of knowledge and it sure was. I'm really grateful that you were able to join us and the topic couldn't be more important. Thank you again for being with us.

Bio

Robert H. Lustig, M.D., M.S.L. is Emeritus Professor of Pediatrics in the Division of Endocrinology, and Member of the Institute for Health Policy Studies at UCSF. Dr. Lustig is a neuroendocrinologist, with expertise in metabolism, obesity, and nutrition. He is one of the leaders of the current “anti-sugar” movement that is changing the food industry. He has dedicated his retirement from clinical medicine to help to fix the food supply any way he can, to reduce human suffering and to salvage the environment. Dr. Lustig graduated from MIT in 1976, and received his M.D. from Cornell University Medical College in 1980. He also received his Masters of Studies in Law (MSL) degree at University of California, Hastings College of the Law in 2013. He is the author of the popular books Fat Chance (2012), The Hacking of the American Mind (2017), and Metabolical: The Lure and the Lies of Processed Food, Nutrition, and Modern Medicine (2021). He is the Chief Science Officer of the non-profit Eat REAL, he is on the Advisory Boards of the UC Davis Innovation Institute for Food and Health, the Center for Humane Technology, Simplex Health, Levels Health, and ReadOut Health, and he is the Chief Medical Officer of BioLumen Technologies, Foogal, Perfact, and Kalin Health.

Study after study has shown that consumption of sugar sweetened beverages poses clear health risk. So how have the big soda companies, Coke and Pepsi in particular, reacted to this news and to public health policies that have aimed to restrict their business dealings like marketing, labeling, and even taxes? A fascinating and important part of this history has been told in a new book by Dr. Susan Greenhalgh called Soda Science: Making the World Safe for Coca Cola. Dr. Greenhalgh is the John King and Wilma Cannon Fairbank Professor of Chinese Society Emerita at Harvard University. But hold on, what in the heck does China have to do all this? Well, we're about to find out. This will be a very interesting discussion.

Interview Summary

Let's begin by setting the context for your book, again, on soda science. Back in 2015, the New York Times published a major expose, written by Anahat O'Connor, and a critique of what was called the Global Energy Balance Network (GEBN), that was funded by Coca Cola. Could you explain what this network was?

Sure. The GEBN was an international network of researchers that argued that the energy balance framework is the best approach for addressing the obesity epidemic. So that simple framework calls for balancing the energy in - the number of calories consumed through eating with a number of calories burned - through moving to achieve a healthy weight. While that sounds neutral in practice, in the early 2000s, Coke and the food industry at large, adopted energy balance as their motto. It had several advantages. One is under the banner of "energy balance," the industry and the scientists working with it could say that people could eat whatever they wanted and then exercise it off. Unfortunately, that doesn't work for most people. Second, in practice, the energy balance slogan was used to promote exercise as the priority solution. What the research shows about energy is that exercise helps, but the primary answer to the obesity issue is to eat fewer unhealthy foods. Now the third advantage to the energy balance framework is that talking about energy balance meant the companies and the GEBN didn't need to mention soda taxes, or other legislative and regulatory measures, that worked but that might hurt the industry.

So, in my book, I call this body of ideas adopted by the GEBN and the food industry “Soda Science.” That's short for Soda Defense Science - a science created not so much to understand obesity, as to defend the profits of the soda industry.

Okay, that all makes sense, and I totally agree with your interpretation of the science that food intake is much more important in the obesity epidemic, in particular, than physical activity. It's not that activity is unimportant, but to divert attention away from the dietary part of it is really a public health misdeed. But one can obviously see the benefit to the industry for making that diversion. So, in that 2015 article, it was highly critical of the conflicts of interest that had been created by the soda industry paying prominent scientists. What benefits did the company reap from making these payments and what happened after that article got published?

The GEBN was the product of the 15 years that came before it, of gradually building up this soda science. The GEBN itself lasted only about a year, but during that 15-year period, the industry benefited by having fewer people, fewer specialists, fewer countries talking about soda taxes. But what happened after the GEBN was outed in the New York Times in late 2015 was Coca Cola was absolutely mortified. The revelation that the company had paid for industry-friendly science was just incredibly embarrassing. So, under absolutely withering criticism from scientists and the public, Coke stopped funding the GEBN, which of course led to its collapse. The company also took a major turn in its approach to obesity. Vowing to no longer single-handedly fund scientific research, and by publishing a long so-called transparency list of all the individuals and organizations it had funded over the last 5 years.

So, those things helped, but Coke's reputation remains tarnished to this day. But meanwhile, as for the academic scientists behind the GEBN, they saw things differently. They continued to maintain that their science had not been affected by the 20 million dollars that Coke had promised to support their network. Of the four researchers who led the GEBN effort, two stepped down and found wonderful jobs elsewhere. They both have leadership positions in different universities. One retired and the fourth continues to work in his previous position. So, there was no single, discernible impact on these debates within the academy.

I know some of the individuals involved. And by the way, I know a good bit of information available to understand what this network was doing came from Freedom of Information requests that various parties made. And your book contains transcripts from emails and things like that, that these various scientists were sharing with the industry. The content of those is extremely interesting and very telling. And the result, it's sort of this good-old-boy-back-slapping-network of people who were kind of winking - let's go get the people that don't like us. It's just interesting. My impression is that some pretty negative consequences befell at least two of those academics afterwards. You know, there was a lot of embarrassment. One basically, I think, had to leave the job he had. Another, suffered some real penalties in his academic life. And so, it wasn't outcome free, or it wasn't penalty free for these scientists at the end of the day. But I do think that your basic point is well made. That lots of people take lots of money from lots of industries on lots of topics. Not just on food, but you know energy and environment and all kinds of things. And very rarely do they pay any kind of a penalty. It only took this investigative report by the New York Times to shed special light on how pernicious this particular one was. But let me ask you a question, and then I kind of have my own thoughts about it. Why don't you think anything more happened to the people that got caught? I don't know if caught is the right word. But at least that they're taking industry money and their favorable science for industry got exposed. Why don't you think more happened about that?

The scientists themselves were deeply convinced that they hadn't done anything wrong. They were convinced that their science was not affected by all the money that they had taken from Coke, and the scientific nonprofit working for the industry, over all those years. I think there's a significant fraction of folks in the public health field, or at least in the obesity research field, who think the same thing. There's just a lot of support for them. As I see it, the two people who lost their original jobs have bounced back. I haven't done a survey of the field to ask people what they feel about these researchers, but they did pretty well given what they did.

The reason I think that they're convinced that they didn't do anything wrong is they have these practices, I call them “doing ethics,” to assure the world and themselves that their scientific integrity is intact. And one of the practices that these guys used was to constantly say, "This problem of obesity epidemic, it's huge. We have to include the food industry as our partner." And then when you go there, food industry begins to have a huge voice and there's very little you can do to effectively restrain it.

You know, it's an interesting way to think about it and consistent with the way I've thought about it over the years. I've done some writing on this topic and it seems to me that scientists have, not all scientists by all means, but a few select ones, get sought out by industry. And then this blind spot ensues where if you ask these scientists sort of, in general, does research get tainted or affected by industry money? They'll say yes. But if you ask does YOUR research get tainted by it? They'll say no. ‘Oh, no, I'm above that. I can be objective We have to change from within.’ There's a whole series of rationalizations for taking the money. But do they ever stop and ask, why is industry investing this money? And industry is not stupid. They wouldn't be paying you $50,000 as a consultant, or putting you on boards, or flying you around the world, or funding your research if there was no return from it. And the research on it is absolutely clear. Industry-funded research typically finds industry favorable results. So, all that's been documented. But the scientists who want to get involved with industry and take the money don't kind of interpret it that way. Like ‘I can take money but be free of the temptations to bias the work I do.’

May I just interject something here? I think that they believe it's a win-win prospect. Of course, Coke wants to emphasize exercise to make people forget about their sugar. But I've just dug long and hard into those emails, which none of the scientists ever thought would be read and used in scholarly accounts. But in the emails, the leader of the GEBN wanted to fund a major research project that he was promoting, and he's arguing all the reasons that Soda Science was good for Coca Cola. I suspect that he thought that Coke wasn't influencing him. Instead, he was influencing Coke. And in fact he was, but it doesn't matter where the influence comes from because in the end the science is affected.

You know, I've often asked myself, if there are negative consequences from this, the question is isn't there a police force out there looking after this kind of thing? And it's hard to know who that would be, because the scientists themselves have shown that enough of them are willing to take the money. And so the scientists aren't policing themselves sufficiently. Their institutions, the universities, tend not to do it because they're taking money from industry, too, in some way, generally. And their university's response to that is you have to disclose that you're taking money from industry. But there's research on disclosure, and that seems to make things worse rather than better. The journals that people publish their work in do the same thing. They make people disclose, but that doesn't have much impact. And professional associations have been investigated every which way by one of the same people who wrote that article in 2015, showing that they take money from industry. So, how can they police their members? So, it seems to me that the police have to be the press and people that do investigative scholarly work like you've done in this book. The book is pretty new. So, it's a little early to say what its impact is going to be. But let's hope that a lot of people read this book. And get more insight into how this works, how people feel when they're involved in this money taking, and what the ultimate impact might be.

So let's turn to one particular area of expertise you have. Let's talk about China. So almost all the criticism on industry-funded efforts like the Global Energy Balance Network have been focused on the U.S. But you follow the soda trail to China. So why did you do that and what's the significance of this inquiry?

Really significant. The GEBN was part of a much larger corporate project that was absolutely global in scope. So, from the vantage point of the industry, the U.S. has long been a declining market for soda. The important markets for sugary drinks are the large rapidly developing countries in the Global South. So that's where the industry is focusing its efforts to sell product, that is junk food and drinks. And to promote a corporate science and corporate policy that stresses exercise over dietary change in soda taxes.

China has 1.4 billion people these days. One billion back in 1980 when Coke set up shop in China. China was the single biggest market for the soda companies. Coke was so keen to get into the China market that it started lobbying early. Actually the mid 1970s, when Mao Zedong was still alive. And in 1978, Coke became the very first Western company to set up shop in China as the country opened up for the first time in 30 years to the market, into the global economy.

And another advantage of the Global South, from the point of view of the food industries, is an attitude toward Western firms that's less critical than what you find in the U.S. In the U.S., huge companies are always under suspicion that they will promote corporate interests over socially valued goals. So those attitudes are much less prevalent in many countries in the Global South where big companies are often seen as agents of development, essential agents. In China, big Western companies were celebrated as sources of capital and advanced interests. So, nobody would suspect they were hurting the country. And the industry has lots of ways of dressing this up in a self-serving, positive way, by talking about developing emerging markets, investments in the developing world, and things like this. But it strikes me also as being stunningly similar to what the tobacco companies did when they got hammered in the United States. They simply moved outside the United States and tried to sell as many cigarettes as beyond our borders as they could. And a lot of these same sort of phenomenon take place. Does that seem true to you?

Absolutely. So let me ask what actually occurred in China. So, Coke sets its sights on China. It has this kind of process established that's trying to affect policy through connections with scientists. So, what actually took place in China? What was the impact on policies?

Well, to understand that, we need to know that the food industry had a magic weapon way back in the late 1970s. The food industry created an industry-funded scientific nonprofit based in DC that was global in scope. And whose job was to sponsor science that served industry needs. Its name was ILSI (International Life Sciences Institute). So, in China, the local branch of ILSI organized a series of major conferences and other activities designed to combat obesity. Over time, the proportion of these anti-obesity activities focusing on exercise rose dramatically, while the proportion focusing on diet sank.What this shows is that the food industry had tilted China's approach to obesity. ILSI China also played a major role in creating China's first and most important policies on obesity. The most important was the National Campaign for Healthy Lifestyles, ironically modeled after the patriotic health campaigns that Mao used to promote in his day. So, that healthy lifestyle campaign drew heavily on the Soda Science created by Coke, ILSI, and their academic friends. So, that ‘healthy lifestyle’ campaign prioritized exercise in a number of ways. Said nothing about sugar and soda. And it made the individual, not the government or industry, responsible for fixing the obesity problem. So, with this campaign, ILSI China had smuggled the policy favored by the food industry into China's policies.

That's an amazing history that you've documented. And it occurs to me that in the United States, we can celebrate public health victories, like the huge decline in cigarette smoking that occurred. And, the big decline that's occurred in sugared beverage consumption too. And those things are all good. But if this is like a balloon and you're just squeezing the end of it here, but it expands elsewhere in the world, the overall public health impact could be even worse than when you started, not better. And it sounds like the industry-funded front groups have been pretty responsible for making that happen.

Yes, they're incredibly effective. In my view, I really took apart ILSI, looking at it as an organizational sociologist. And I think it's just brilliantly designed to make academic-looking science that benefits industry. And to keep everything hidden from sight under that label nonprofit. It's really quite brilliant. They're not very happy with this project.

And the work that you've done, and the investigative journalists have done in the U. S., to expose these industry ties can have traction in the U. S. much more so in a country like China. So, it sounds like there's probably not much to put the brakes on this kind of thing in China. Is that right?

To tell the truth, there's a younger group of obesity experts, trained in the U.S., who now are based in China and have written major articles. There was a three-part series in The Lancet in 2021 on obesity in China. And they are on board with a critique of the food industry and working in every way they can to bring that to the attention of officials. But the government has a vested interest in the success of Coca Cola. I have to say that Coca Cola, and there's a huge state-owned enterprise called COFCo, they now have a partnership called COFCo Coca Cola, that runs the bottlers in 19 provinces, representing something like 60-70 percent of the Chinese population. So, the government has a vested interest in making sure Coca Cola remains happy.

Let's talk about that just a bit more. So, Susan, you'd think that the Chinese government would be in a conflicted position with this. On one hand, they want to financially benefit from Coca Cola prospering in their country. And I'm sure officials are benefiting individually from that kind of thing. But the country doesn't benefit because they certainly don't want high rates of diabetes and heart disease and obesity and other things that come from consumption of these products. How do you think that that plays out? Is it just that the short-term financial benefits are prevailing over the longer-term health consequences?

I think the government is highly conflicted. It has a number of policy, overarching policy themes, that it has been promoting ever since opening up in the late 70s and early 80s. One of those themes is marketization, growing the economy, advancing the technology in high end industries. And nothing can interfere with the achievement of that goal. China is known around the world for having very sophisticated environmental policies. But when push comes to shove, market goals prevail over environmental goals. I think the very same thing happens with health. It's just astonishing to see how market forces and market logics pervade the health sector. I did a separate piece of research, it's not in this book. But it shows that the major western food companies have been partnering with the Chinese government to carry out China's policies on chronic disease. And that means they're teaching the Chinese people basic notions of good nutrition. And what they're teaching them is not that soda is bad, is that, you know, it's that you can drink soda as long as you go ahead and exercise at all. I think there are major fundamental conflicts here at the level of profound party policy. I think this is going to be very hard to address.

I was going to say that's just a stunning observation. That part of the food nutrition education has been turned over to the food industry.

Absolutely. And you can, you can read about it in the Chinese media every year. They have, it's called Food Week or Nutrition Week, that's sponsored by the Chinese Nutrition Society, which is nominally independent. And they invite Western food companies to come in and sponsor a big project within that week. And of course they're very happy to do it.

Unbelievable. So, a chapter of your book is entitled Doing Ethics, the Silent Scream. What do you mean by that?

Let me start with just a little bit of background. So, in China, the head of the ILSI branch operated as a virtual health ministry official. Kind of a de facto part of the government. So, no one could question what she did, part of the government, no questioning the government. As I just mentioned, most of the scientists I interviewed believed that Coke and other food and beverage companies were positive forces in China. They loved Coke's corporate social responsibility programs and had them all in their head and regaled me with these stories of schools in the rural areas supported by Coke. They thought everything was above board. They thought that ILSI's science was objective or disinterested. They couldn't imagine that Coke was supporting policies that benefited the corporate bottom line while harming the health of the Chinese people. Now, getting to that chapter, some very senior scientists, folks who had worked in the field before money came to dominate everything in China, they knew in their hearts that the food industry was corrupting China's science and policy. But it was very dangerous for them to talk about it. They certainly didn't volunteer those feelings to me. But when I began to ask really probing questions, they quietly acknowledged that yes, of course, corporate funding shapes the science. But the whole subject caused them just incredible angst. They couldn't talk about it. They certainly couldn't talk about it in public, and they couldn't do anything about it. And so, they issued a silent scream. And this is a really important part of the story of China. There really are voices of resistance, voices that see through the official line that everything's being done correctly. The readers of this book can hear that silent scream in that last chapter.

That's a pretty, pretty amazing story. Well, you know, it's heartening in a way that in a country like China, where the government controls so much of what day to day life is like, that there is some activity. At least some pushback, some resistance. So, let's hope ultimately that the objective science prevails. That the industry influence wanes, and the public health will be protected. So, speaking of chapters in your book, the last two chapters are titled, Soda Science Lives On. And then the final chapter, So What and What Now. Tell us more.

Oh sure, I'd love to. Soda Science Lives On: that's like the conclusion to the China part. I show how, even to this day, the provisions of Soda Science continue to shape China's policies on obesity and chronic disease more generally. In the last decade, President Xi Jinping has stressed the importance of including health in all policies, which is good. But a close look suggests that his signature policy package, that's called Healthy China 2030, bears the imprint of the Coca Cola company and -promotes ILSI's trademark exercise programs that omit soda taxes. And have a strong market orientation that makes individuals, again, not companies, not even the government, fundamentally responsible for maintaining a healthy weight through their healthy lifestyle choices. This, of course, neglects the importance of China's obesogenic environment and the impact of that environment on the choices available to individuals. So, this part of the book also introduces a group of next generation Chinese scientists who understand the threat posed by big food constantly lobbying the government to introduce policies to restrict its power.

I've talked about the impact on China, but I'm also very interested in the impact on America, especially American fitness culture. In the book's conclusion, what I do is I take the short history of Soda Science. And I place that in the context of the much larger history of the post-World War II history of American fitness culture. What I suggest is that Soda Science was instrumental in creating today's Fitbit wearing, step counting, exercise and obesity-obsessed culture that assumes that exercise by itself can take off pounds. That 10,000 steps a day is going to solve all my problems. It won't, but the idea is very much part of our everyday thinking about obesity. There's a lot of work to do.

As we all know, those big food companies are some of the wealthiest and most powerful forces in the world. Way richer than any of any fields of science in America. For critical scientists and social scientists, the effort to chip away at their power through the power of expose and documenting the truth often feels quite futile, time consuming and useless. But in fact, our work can make a difference. And I document this in the book. In the last few years, Coca Cola cut its ties with ILSI. That is big because Coca Cola was the founding company behind ILSI. Two other companies have also dropped ILSI. ILSI itself has also undergone a major reorganization and this is big - ILSI China has dissolved. It is no longer.

I'd like to think that the in-depth research of the social sciences has exposed what is really going on and left these corporate science organizations little choice but to close shop, or fundamentally change how they work. That's my secret dream. So this, this is progress, yes, but the food industry is still at it, for sure. Especially in the Global South. The industry is focusing its energies on defending junk food and drinks by opposing regulatory measures that have proven successful. You know, taxes, front of package warning labels, marketing restrictions and so on. So even in countries that have developed, often with the assistance of American researchers, really impressive chronic disease prevention programs, the industry has been moving aggressively to weaken, delay, or block them. Our work has just begun. And I really hope some listeners will be, will be encouraged to join the force of all of us working to expose and change how things are happening.

BIO

Susan Greenhalgh is John King and Wilma Cannon Fairbank Professor of Chinese Society Emerita in the Anthropology Department and Fairbank Center for Chinese Studies at Harvard University. A former Guggenheim fellow, she is a specialist in the social study of science, technology, and medicine, especially as these intersect with questions of policy, governance, and the state.

Her latest book, Soda Science: Making the World Safe for Coca-Cola (2024), uncovers the secret strategies by which Big Food, working with allies in academia, created an industry-friendly, “soda-defense” science of obesity that argued that the priority solution to the obesity epidemic is exercise, not dietary restraint, and that soda taxes are not necessary – views few experts accept. For 15 years the “soda scientists” were highly successful in promoting these ideas, eventually getting them built into Chinese policy, where they remain today. An earlier study of the American obesity epidemic, Fat-Talk Nation: The Human Costs of America’s War on Fat (2015), illuminates some of the unexpected consequences of the national panic over obesity for the bodies, lives, and selves of vulnerable young people. Under the Medical Gaze: Facts and Fictions of Chronic Pain (2001) presents a case study of iatrogenic injury, illustrating medicine’s power to define disease and the self, and manage relationships and lives, and sometime induce suffering.

As a society, we are eating and drinking low-calorie sweeteners more and more. Researchers are working to understand the long-term impact of such sweeteners for adults and, of course, for children. This interview is part of a series on the impact of sweeteners. Our guest today is Dr. Allison Sylvetsky, Associate Professor in the Department of Exercise and Nutrition Sciences at the George Washington University - Milken Institute School of Public Health.

Interview Summary

Boy, these sweeteners are in the news all the time, and that's been the case for many years. And people are really interested in whether they're safe, whether they help people control their weight and the like. You have a vast knowledge on this, and I'd like to begin with kind of a fundamental question. So, how has the consumption of these sweeteners changed over time? How much are they being used and who is using them?

What's really interesting is that these sweeteners have been around, at least some of them, for quite a while. But what we've seen is that as there's been more and more emphasis on reducing the consumption of added sugars and sugar sweetened beverages, there's been a widespread increase in the use of various low-calorie sweeteners in the food supply, which of course has been followed by increases of consumption. So, across all different population subgroups, we're seeing increases in the intake of low-calorie artificial sweeteners.

So, how much are they used and who are the people who are using them the most?

So, in terms of how much they're used, that depends to some extent on how we look at this, because it's very hard to actually quantify the intake given that manufacturers are not required to disclose the amount of different artificial or low-calorie sweeteners in food and beverage products. So, most of the data that we have to rely on either comes from household purchasing data or comes from self-reported dietary intake data from large surveys, for example, the National Health and Nutrition Examination Survey. But, what we've seen in these data are that low-calorie sweeteners are being used across the population, though the highest consumption or highest prevalence of consumption is seen in females, in individuals with diabetes and obesity, individuals from higher-income households, and also older adults and older individuals. However, more and more, we are also seeing consumption of low-calorie sweeteners among children, and consumption in products that people wouldn't necessarily expect would contain these artificial or low-calorie sweeteners.

Let's talk about that. So, where do the low-calorie sweeteners show up in the food supply? Has this changed over time?

This has definitely changed over time. Several decades ago, you would think of low-calorie sweeteners as being in diet beverages, which of course they still are. Or in sweetener packets that you find on the tabletop. For example, Sweet'n Low that contains saccharin or Equal that contains aspartame. But now we're seeing these sweeteners showing up across product categories. So, in products including light yogurts, artificially sweetened yogurts, dairy desserts such as ice cream, snack foods such as microwave popcorn, cereals, ready-to-heat oatmeals, all sorts of different products, protein bars, protein shakes, really, you name it. I've actually even seen low-calorie sweeteners show up in pickled ginger that usually is used along with sushi. So, again, places where people just wouldn't expect to find them. We see these sweeteners popping up, and this is more and more the case as there's been more and more emphasis on reducing the intake of added sugars.

Low-calorie sweeteners in microwave popcorn, who would've thought? I mean, that's just one example and you gave other ones about where these things are showing up. So, big time exposure to these, isn't there?

Exactly. Also, something like microwave popcorn typically wouldn't be thought of as a diet food, and that's part of what is very confusing to consumers. It's one thing if the product is labeled as "diet" or "no sugar added" even. Not that everybody would recognize that as perhaps being suggestive of having a low-calorie sweetener, but in products like microwave popcorn or certain English muffins, for example, people typically aren't using these products as a way to manage their weight or as some sort of a diet or reduced calorie food, because they're not diet or low-calorie foods.

Let's get right to one of the most fundamental questions of all. What are your thoughts on how these low-calorie sweeteners affect health?

So, that is the big question, and there's a lot of uncertainty and there's been more and more research on the topic, which has been exciting and informative. But there still are a lot of questions with regard to how these sweeteners affect health. One thing that is important to clarify right from the start is that, at least the work that I do and the work that a lot of people are focused on to understand their health effects, is different from more of a traditional toxicological safety assessment. So, when I'm talking about their effects on health, I'm really referring to their metabolic and health effects, their role in weight management and chronic disease prevention as opposed to more traditional safety outcomes. Because of course, these low-calorie sweeteners have been reviewed and approved for use in food by the Food and Drug Administration and other regulatory agencies worldwide. But, in terms of weight management and chronic disease prevention, what's really interesting is, it depends on the type of evidence that you look at. There have been quite a number of randomized control trials primarily in adults that have shown that when added sugars or sugar-sweetened beverages are replaced with low-calorie sweeteners on a one-to-one basis, there typically is either a neutral effect or a modest benefit. Where we do see some modest reductions in energy intake as well as a modest reduction in body weight. But that doesn't necessarily tell the whole story because that doesn't necessarily reflect how they're used, especially given what we've just discussed about the use of low-calorie sweeteners in the food supply. What's interesting is when we look at observational evidence from large perspective cohort studies, typically the vast majority of these studies show positive associations between consumption of diet beverages and low-calorie sweeteners with a variety of adverse health outcomes. This includes higher risk of obesity, higher risk of diabetes, heart disease, and some recent studies also showing an increased risk of certain types of cancer.

So that then leads to the question of: well, what explains this discrepancy? There are several explanations. One is that there are flaws to any type of study, including that a lot of these studies that look at associations may be subject to reverse causality or sort of a chicken and egg situation - which is what's happening first. But they're also very plausible biological and behavioral mechanisms that have been put forth to explain how low-calorie sweetener intake may be causally related to some of these outcomes. And that's really where a lot of the research is focused right now, is trying to understand, what do these low calorie sweeteners actually do metabolically in the body and how does that impact health?

That whole range of metabolic consequences is a very interesting one. You led off this discussion by mentioning toxicology, and I realize that you're not a toxicologist, nor am I, but I do have a question in that arena. Whatever standards of the FDA uses to assess safety for these things, I'm assuming it's a range of standard toxicological tests, do you think there's still a chance that these things, even though they're considered safe, will have long-term consequences that people don't know about yet? Just because some of the newer ones, for example, haven't been on the market long enough for people to have 20 or 30 years of exposure? Is there a reason to be concerned on that front, do you think?

I would say there's a reason to be concerned in terms of while the levels that they're consumed are believed to be safe in terms of, as you said, these thresholds that are set forth based on toxicological data - we don't know what the threshold of exposure is that would be required to have these metabolic effects. When we're talking about metabolic and health effects, as you've alluded to, these are long-term processes, right? We don't develop diabetes or cancer overnight, but it takes months, years, decades of exposure to see some of these outcomes. So, it is very possible that even though these are safe from a toxicological standpoint, the repeated exposure in the ways that we consume them, in addition to the fact that we don't consume these in isolation, we consume low-calorie sweeteners in combination with each other, other low-calorie sweeteners, as well as other food additives, other ingredients in various forms. So we don't fully understand yet what that means for long-term human health.

Thank you for that explanation. Thus far, we've been talking about these low-calorie sweeteners as a group, but of course there are different compounds that have different biological effects. What do you think about the different effects of the different versions of low-calorie sweeteners?

That's become an extremely important question, especially because over time there's been changes in not just the use of low-calorie sweeteners as a group, but in certain low-calorie sweeteners. As you mentioned, these sweeteners are different compounds. Of course, they're grouped together because they contain characteristics, such as low-calories that have high potency sweetness and are palatable replacements for added sugars in food. But they are of course, different compounds. And therefore, while they may have some overlapping effects due to their sweetness, they also may have different effects due to their specific chemistry and their way that they are absorbed, metabolized, processed in the body. That's something that we're really, as a field, just beginning to understand. In a lot of the research to date, low-calorie sweeteners have been referred to as a group. And that's in part because, especially in observational studies, it's very difficult to tease out which ones are being consumed. And that's in part due to limitations of dietary assessment approaches, and in part due to constantly changing formulations of these products by food and beverage manufacturers.

So, it's difficult in a lot of the existing research to actually tease apart what specific low-calorie sweeteners we're talking about. That said, there is more and more of an emphasis on trying to understand these as individual compounds and then hopefully be able to make more tailored and nuanced dietary recommendations for or against their consumption. There's been some recent studies looking at, for example, comparing different low-calorie sweeteners on outcomes such as body weight over 12 weeks. What that study showed (that was a study out of Purdue University), is that while saccharin consumption actually led to weight gain that was similar to real sugar, sucralose consumption in this particular study led to reductions in body weight. So, while this is just one example, clearly it's possible and likely that these sweeteners may actually have some different effects, which really reiterates the need to look at them separately and compare their effects on different outcomes.

It's interesting that you mentioned the research at Purdue, and I'd like to remind our listeners that we reported a podcast with Dr. Richard Mattes, who's a professor at Purdue, who's done a good bit of work on this topic. So, let's turn our attention to children. And I know many parents are very concerned about consumption of these products by their children. So, is their worry warranted? What do you think about use of these things in children?

Yes, I would say their worry is warranted. That said, it's also not conclusive that these are harmful, but at the same time, it's not conclusive that these are actually beneficial for their intended benefits of helping to reduce sugar intake and help with weight management. Really when it comes to kids, it's a question of how you look at the data, because what is obvious is that there is a lack of data in kids. In some cases, kids could be thought of as small adults. But kids also are very different than just being small adults, not just because they're smaller, but because they're developing. And we know that early life exposure makes the difference in terms of future dietary patterns. Given that there are many questions about the metabolic and health effects of low-calorie sweeteners in adults that have yet to be answered, to start in a widespread manner, providing these to children is concerning until we have a better handle on how these actually work in the body. As mentioned, there is very limited evidence in children, but at the same time, we've seen an explosion of low-calorie sweeteners in products, including products that are directly marketed to children. For example, fruit drinks that have often added sugar in addition to low-calorie sweeteners such as sucralose and acesulfame potassium. We've done some work talking to parents as have others, and trying to understand, "Well, what do parents think about this?" And most parents will tell us that they do not want to provide these to their children. Meanwhile, other research has shown that parents cannot identify or recognize products that contain them. What's happening is that given a lot of different factors, but particularly the fact that more and more of these sweeteners are showing up in children's products, children are being exposed to low-calorie sweeteners from a very young age. And it's unclear what that means for their health. There is reason to be concerned, both based on data in adults as well as some of the more mechanistic evidence that's come out recently related to how these sweeteners may adversely impact glucose homeostasis or insulin resistance, or alter the composition of the gut microbiome. There are a lot of questions when it comes to this topic in general, but particularly for children, it would seem that we may want to take a more cautious approach before widely incorporating these into products that are going to be consumed by youth.

What are some of the key questions that people in this field are addressing now?

So, some of the key questions, and there are many of them, but one is really just to understand the mechanisms through which these sweeteners work, both as a group and individually. That will provide really much needed insight to explain these epidemiologic findings and also to understand some of the discrepancies between the randomized control trial literature and the observational data. That's one big area of focus. Another is to understand early life exposure. Both exposure among children as well as intergenerational exposure. What happens when a pregnant mother or breastfeeding mother consumes these every day or multiple times a day? We know that they are transferred to the baby. In the case of breastfeeding, for example, we've done some work in that area. What we don't know is what that actually means for the child in terms of their taste preferences, their appetite, their weight trajectory, and their future health. Understanding that early life exposure and intergenerational transmission, as well as focusing on cardiometabolic outcomes beyond body weight. So, we know that when these are used in a certain way, very judiciously, these may... Low-calorie sweeteners, and I'm generalizing the term here, but may be useful for helping with weight management. But we need to study these in a way that better reflects how they're actually consumed in real life. And then also, as we've already discussed, really start to understand the effects of these different compounds as individual sweeteners in addition to as a group of compounds that have some similar sensory property, that being that they're sweet. I think those are some of the main areas in addition to continuing to translate some of the more mechanistic work that's been done in rodent models into the context of human consumption.

The whole idea behind these artificial sweeteners in the first place is that people enjoy sweet taste in things. And so, why not go ahead and provide that? And it better to have it in some form that's not creating the same health problems that sugar has. But what about just changing that assumption and saying that people should get accustomed to less sweetness in things overall, which would then lower intake of both artificial sweeteners and sugar. And I'm wondering if you think that might be possible? Let's just say that the food industry agreed to or was required to reduce the sweetness in its food by 5% each year for the next 15 years or whatever it would be, so that people wouldn't notice it from year to year, but generally you would get accustomed to lower levels of sweetness in things. Do you think that would be possible for people to become accustomed to?

I would think it would be possible, certainly that we know that repeated exposure to different levels of sweetness will affect sweetness preference and dietary choices. What you're describing is very similar to what's been done with sodium in terms of gradual voluntary reduction of sodium. And I am aware, and as I'm sure you are, of efforts through, for example, the National Salt and Sugar Reduction Initiative (NSSRI), to do exactly that, which is to set targets for lowering the sugar content and therefore lowering the sweetness, assuming that there's not replacement with low-calorie sweeteners of different products across different product categories. I think there is a lot of promise in that concept, but I do think we would need to obviously see how that actually affects various outcomes before knowing whether it was effective or not. But I think that concept of it's not just sugar, but also we need to think about the sweetness and how that pertains to other dietary choices and longer term dietary patterns, is really important.

Bio

Dr. Allison Sylvetsky is an Associate Professor in the Department of Exercise and Nutrition Sciences and is Director of the Bachelor of Science in Nutrition program at the George Washington University Milken Institute School of Public Health. Dr. Sylvetsky joined the GW faculty in 2014, prior to which, she was a post-doctoral fellow in the Diabetes, Endocrinology, and Obesity Branch of NIDDK in the Intramural Research Program of the National Institutes of Health (NIH). She received a doctorate in Nutrition and Health Science from Emory University. Dr. Sylvetsky's research focuses broadly on obesity and diabetes in youth. Her primary research interests are in studying the consumption and health effects of sugar-sweetened beverages and low-calorie (artificial) sweeteners, with a key focus on their consumption during childhood.  

In 2016, the Chilean government implemented a comprehensive set of obesity prevention policies aimed at improving the food environment for children. Results from a multi-year study of that regulation, published in the International Journal of Behavioral Nutrition and Physical Activity, can now tell us if Chilean children are better off as a result of the policy. Guests on this podcast include: Dr. Gabriela "Gabi" Fretes. She is an Associate Research Fellow at the International Food Policy Research Institute. Dr. Camila Corvalan is the Director of the Center for Research in Food Environments and the Prevention of Chronic Diseases Associated with Nutrition at the University of Chile. And, Dr. Sean Cash is an economist, Associate Professor of Agriculture, Food, and the Environment, and the Bergstrom Foundation Professor in Global Nutrition at Tufts University.

Interview Summary

Sean, let's set the stage for this conversation. When crafting food policy, what should policymakers consider with respect to children and adolescents, both as current and future consumers in the food system?

I would argue that children and adolescents should be a priority, if not the priority in how we consider dietary policy for a few reasons. In the United States and elsewhere, we often argue quite heatedly about the proper role of government, with the arguments for health-promoting policies seemingly running into conflict with concerns about paternalistic interventions and restrictions on personal choice. These are important and perhaps unavoidable discussions to have. But when it comes to kids, we've already long had standards for school meals, what packaged snacks can be sold in schools, etc. We don't treat children as legally independent in other ways. So while there's still a lot of room for disagreement, it may be less daunting to actually keep child nutrition in the forefront when we consider how food policies around diet need to evolve. Perhaps more importantly, I would note that food marketers have long seen children as an important three-in-one market. One, kids have influence over food choices within their households. Think of a kid shopping with a parent in a supermarket and pointing at things she'd like mom or dad to buy. We sometimes call this pester power. Two, kids have their own spending money, and much of what they choose to spend it on is food. Often the types of energy-dense, nutrition-poor snack foods that are exactly the foods subject to labeling under the Chilean law we're talking about today. And three, kids grow up to be adult consumers, and their preferences and knowledge are heavily influenced by the things to which they're exposed in childhood. For the same reasons that food marketers are interested in children, policymakers should be. Kids have influence in in their households now. They're buying food on their own now. What they do now will influence their future behaviors and future health.

Thank you, Sean. I have got to say, I went grocery shopping with my child yesterday and I appreciate your thoughts on how we should think about what policymakers should engage, not just in the U.S. but anywhere when we are thinking about helping kids make good choices that will have long-term implications. Thank you for that. I want to turn our attention to the research paper that we're discussing now, titled, "Changes in Children's and Adolescent's Dietary Intake "After the Implementation of Chile's Law "of Food Labeling, Advertising, and Sales in Schools." So, Gabi, my question to you is this. One of the key components of the Chilean law was regulating food offerings in schools. Can you explain the focus of that policy and how it is intended to work?

Yes. Before we speak about schools, we should speak about Chile's law in general. Chile's law of food labeling and advertising includes three main components. The first one being mandatory front-of-package warning labels on packaged foods and beverages. The second being restrictions on all forms of food marketing directed to children younger than 14 years. The third one is school regulations at the preschool, elementary, and high school levels. Briefly, food manufacturers must place front-of-pack warning labels on packaged foods and beverages that are high in added total sugars, saturated fats, sodium, and energy. This law was implemented in stages starting in June, 2016. The law mandates that food and beverages with at least one front-of-pack warning label cannot be sold, promoted, or marketed inside schools. That includes school kiosks, cafeterias, and events that happen inside schools. Additionally, food and beverages with front-of-pack warning labels cannot be offered as part of the school meals program or as free samples or gifts. Chile's set of regulations is unique because it includes a package of interventions covering several aspects of the school food environments, such as the availability of foods for sale inside schools, school meal program standards, and restrictions on food marketing directed to children.

Wow, Gabi, this is a very comprehensive law. So what did the team hope to test in the longitudinal study? Could you explain the main findings?

Yes. So with this study, our team aimed to assess if children and adolescents' intake of total sugars, saturated fats, and sodium consumed at school changed after the initial implementation of the regulation. The team was also interested in exploring how children navigated different food environments. We also evaluated changes in intake at home and different settings from home and school. So, what did we find? Intake of most nutrients of concern, those nutrients under the scope of Chile's law, including total sugars, saturated fats, and sodium significantly declined at school both for kids and adolescents. At home, we also found significant declines in kids' total sugar intake, but no changes for adolescents. What makes this more interesting even is that we found evidence of partial compensatory behavior at restaurants, corner stores, street food, among others. Which means that kids and adolescents were consuming less healthy foods outside their school and home.

Thank you, Gabi. I want to now turn to Camila. I'm really curious about this compensatory behavior. The study found this evidence of students compensating somewhat for the healthy foods at school by eating more sugars, saturated fats, and sodium at other locations outside of school. Why do you think this happened?

Norbert, I believe this is a very interesting finding, and there are probably three main reasons why we observed this result in the study. First of all, we know that children, as they age, start to consume much more food from places outside of home. This is something that has been shown previously. We know that when kids start to age, they start to get more sugar, more saturated fat, more energy from restaurants and fast food outlets. This is something that we would expect in a longitudinal study such as the one that we conducted. Secondly, the Chilean law did not include regulation around the schools - so in the neighborhoods that surround the school. This was originally part of the regulation. But, during the discussion and designing, we had to drop this component of the regulation. Basically what we approved is that there were restrictions in the schools, but outside there was no restriction in terms of marketing or the offer of unhealthy foods to children. Finally, it's likely that the regulation influenced some kids in a positive way. They really changed their behavior. But it's also possible that other kids did not really change their behavior. Once they had the opportunity of going outside of the school, they just kept buying unhealthy foods with high content of sugar, saturated fat, and sodium.

Thank you so much for that. It does reflect the complexity of the decision patterns that children have in terms of how they eat. I think this is true for all of us. If we are trying to improve in one area, there may be some changes in other areas. But I want to pick up on something you said about why you believe the result occurred the way it did. It had to do with dialogue that went on in Chile about the law. So, I want to ask now, how can we best center the needs and voices of communities in the development of similar regulations? It sounds like some of this happened in Chile. Could you share your thoughts about this?

Yes. So, during the process of developing the regulation in Chile, the Ministry of Health held some participatory discussion throughout the country with families, parents, school teachers, and different stakeholders to actually get their ideas and also assess their concerns about the different components of the regulation. We do believe it's very important to include the community's views when we define this kind of policies or programs because what we actually want to modify is people's behaviors. We really want to understand what is the best way of actually achieving that transformation. We really need to get their view for doing that. In Chile, we did not have a very strong civil society organization that could coordinate these views, and that is why the Ministry of Health had to actively engage the community through participatory dialogues that actually delay a little bit the implementation of the law. But, we believe that certainly strengthened their application.

It's really interesting to hear about this deliberative process and to see what ultimately came out of that. I want to turn my attention back to Gabi. In the big picture of policymaking, what can we actually learn from Chile's experience with the food labeling law?

Thank you, Norbert, and I think that we can learn a lot. But, I will highlight three things that we learned from this study. First, I want to say that Chile was the first country in the world that implemented front-of-pack warning labels on packaged foods and beverages high in sugar, sodium, saturated fats, and calories. So, the first thing that I want to highlight is that what's unique about Chile is that it wasn't only a labeling regulation but a comprehensive set of actions that included restrictions on marketing as well as school regulations. Food environments as a whole should be conducive to healthier and sustainable diets, and therefore isolated actions would be limited in scope. However, we need to acknowledge that the policy process in Chile was not without complications because there was significant pushback from the food and beverage industry. This is something that countries in the process of designing or implementing similar regulations should expect to happen. They should be prepared to respond with arguments based on evidence. The second highlight is that our results showed that the set of policy interventions may be promising to improve kids and adolescents' diets at school, but that actions in out-of-school settings should be strengthened to improve overall diets. So for example, I will cite some actions that could complement these regulations, such as the introduction of junk food taxes, the reinforcement of nutrition education in schools and the community, particularly relevant now as we move into the post-COVID-19 era, social marketing campaigns, actions in other settings such as menu labeling in restaurants, improving the availability and acceptability of healthier foods by street vendors, among other actions. And lastly, the third point that I want to highlight is that moving forward, countries should consider equity aspects to overcome structural barriers that limit people's ability to choose healthier foods and combine mutually-reinforcing strategies to stimulate a holistic food systems response where everyone has access to and can afford healthier foods.

Thank you for those comments, and I really do appreciate this idea of even though this was a comprehensive law, that there are some other spaces that the law could touch on or think about because of the results that we saw with this compensatory behavior. Thank you for sharing that. Sean, my last question is for you. I'm wondering if you could share your thoughts on whether Chile might serve as an example to inform the current front-of-package label discussions we're having right now in United States.

Oh, absolutely. Chilean law has already served as a model for consideration in many other countries in the region and around the globe, including in our top food trading partner, Mexico, which enacted a Chilean-style labeling law in 2020. Several multilateral health organizations have also expressed support for the Chilean approach to be used elsewhere. And it's hard to argue against the logic of policymakers in the United States paying close attention to what works well and what doesn't work in other countries in considering any policies around dietary guidance that we choose to pursue here. But for me, one particularly compelling part of the Chilean law that we should pay attention to in the U.S. is how the standards are consistent, and that the same foods that bear the front-of-pack warning labels are those that are restricted in schools and cannot be marketed to children. Looking for opportunities for similar types of harmonization across different areas of dietary guidance and policy within the U.S. moving forward would certainly help with consumer education, and I think would make sense in other ways. And one interesting thing to keep in mind when talking about the use of mandatory warning labels in a U.S. context is that there are some potentially binding limits on what the government can or can't compel food manufacturers to put on a food pack. Think of cigarette labels for a moment. We've long required that cigarette packages have the rather bland, plain text Surgeon General's warning that we're all familiar with seeing. But in the late 2000 aughts, the FDA proposed rolling out a series of graphic warning labels modeled, in part, on similar images used in other countries. And in that case, the effort was scrapped because of a widespread concern that requiring tobacco manufacturers to put a picture of a body in a morgue with a body tag on it, for example, is interpretive language that appeals to an emotional response, and that this would actually be a form of government-compelled speech that runs up against our First Amendment protections in a way that a scientifically-factual, text-only statement would not. While I personally don't know that the Chilean labels would be interpreted in the same way here, I'm quite certain that legal challenges would be raised to clarify this question in the U.S. context. So, it might be a little bit tougher to take some warning label approaches here in the United States than what we've seen enacted elsewhere.

Bios

Gabriela (Gabi) Fretes is an Associate Research Fellow in the Nutrition, Diets, and Health (NDH) Unit of the International Food Policy Research Institute. She received her PhD in Food and Nutrition Policies and Programs at the Friedman School of Nutrition Science and Policy, Tufts University, USA in 2022 and holds a Masters in Food and Nutrition with a concentration on Health Promotion and Prevention of Non-Communicable Diseases from the Institute of Nutrition and Food Technology, University of Chile. Her research interests are at the intersection of child obesity prevention, food policy and consumer behavior, and her doctoral thesis involved evaluation of a national food labeling and advertising policy designed to improve the healthfulness of the food environment and address the obesity epidemic in Chile, particularly among children. She has worked with a broad range of government, international organizations, academia, public and private sector stakeholders and decision-makers in Paraguay, Chile, and the United States of America.

Camila Corvalán is a surgeon, a Master in Public Health, and holds a PhD in Nutrition. She is the Director of the Center for Research in Food Environments and the Prevention of Chronic Diseases Associated with Nutrition (CIAPEC), at the Public Health Unit of the Institute of Nutrition and Food Technology (INTA) of the University of Chile.
CIAPEC is dedicated to the population study of the early nutritional determinants of obesity and associated chronic diseases, particularly metabolic diseases and breast cancer. Their work focuses on carrying out longitudinal epidemiological studies (both observational and intervention) in stages considered critical for the appearance of these diseases, such as pregnancy, childhood, and adolescence, considering various determining factors in both the environment food (set of factors that define population feeding patterns) as individual. CIAPEC is a part of the international network INFORMAS for monitoring food environments, and also carries out policy evaluations such as the Chilean Labeling Law; CIAPEC works in coordination with several governmental bodies.

Sean Cash is an economist and associate professor of agriculture, food and environment at Tufts University. He conducts research both internationally and domestically on food, nutrition, agriculture and the environment. He is interested in the environmental impacts in food and beverage production, including projects on crop quality and climate change, consumer interest in production attributes of tea and coffee, and invasive species management. He also focuses on how food, nutrition, and environmental policies affect food consumption and choice, with specific interest in children's nutrition and consumer interest in environmental and nutritional attributes of food. He teaches courses in statistics, agricultural and environmental economics, and consumer behavior around food. He is currently Editor of the Canadian Journal of Agricultural Economics and on the editorial board of Agribusiness, and has served as the Chair of the Food Safety and Nutrition Section of the Agricultural and Applied Economics Association.

With the widespread presence of artificial sweeteners in the food system, scientists and consumers want to know about their safety. Safety concerns have been expressed for years, and lots of research has been done, but relatively new on the scene is work examining the effect of sweeteners on the microbiome. This interview is part of a series on the impact of artificial sweeteners. Our guest today, Dr. Jotham Suez, is doing fascinating work on this topic. He's Assistant Professor of Molecular Microbiology and Immunology and the Public Health Johns Hopkins University.

Interview Summary

So most everyone knows of the microbiome, but not everybody knows exactly what it is and how it works, so I'm hoping we might start with a quick overview of the microbiome. Could you help us with that?

Sure, so I would say there are three really important things to know about the microbiome. We know that there are trillions of microbes, bacteria, and viruses living in our body. What everyone should know is that most of the systems in our body require these microbes for their proper development and proper function throughout our lifespan, so without these microbes, our immune system, and even our brain, would not develop properly, and if the microbiome is perturbed, this can lead to development of various diseases. That is the first thing. Already this implies that the microbiome is amenable to change, which is actually something that is attractive facet about the microbiome. If we know that the microbiome is involved in the pathogenesis of various diseases, then we can use that to our advantage, and we can think of way to change this microbial community to help protect us against disease, or even treat diseases in which the microbiome plays a role in the pathogenesis. The third thing that we should all think about is that the microbiome is some sort of a fingerprint. Each one of us has a unique microbial community in their body, and we can use that person-to-person difference in the microbiome on one hand, to predict disease risk. This is because some people would harbor the microbes that make them prone to diseases. We can also use that to tailor various drugs or various diets, or various therapeutics, to that community, because we would be able to say, based on your microbiome, how you would respond to a certain therapy or a certain diet. Heterogeneity in the microbiome plays an important role in personalized medicine.

Thanks for helping establish how important the microbiome is, and also, how it can be affected in both positive and negative ways. So in that sense, what got you interested in the impact of artificial sweeteners on the microbiome?

Yes. I think it was the person-to-person heterogeneity, and how that can lead to differential responses to diets or therapeutics. Just like you said, there have been decades of studies on efficacy of artificial sweeteners or potential safety concerns about whether they are helping us lose weight, helping us maintain healthy blood glucose levels, or they are actually doing the opposite. The studies are really all over the place. You would see studies that support a beneficial impact and studies that demonstrate detrimental impact. We were wondering as we started this research, if it's possible that this heterogeneity in outcomes of the studies is related to heterogeneity of the microbiome. Is it possible that some people are negatively impacted and some people are positively impacted, whether this is related to the differences in their microbiome.

That's a fascinating area, and interesting to think that the same substance may have much different effects on people. So how have you gone about studying this yourself, and what have you found?

We started very naively. I started when I was still a PhD student. I went to the supermarket, I purchased sachets of the most common artificial sweeteners that are out there, and we added that to the drinking water of mice. We saw that mice drinking these artificial sweeteners developed glucose intolerance, meaning they had poorer response to a simple sugar, which is how you would predict or diagnose pre-diabetes or diabetes in the clinic, for humans. We were able to show for the first time that sweeteners can actually cause negative impact on the metabolic health of an animal. What was more interesting is that we saw that these sweeteners also changed the microbiome of the mice drinking the sweeteners. What we've done then is take the microbiome of the animals that were drinking sweetener and we transplanted these microbes into mice that don't have any microbiome of their own. Just by giving them the microbes of mice that were drinking sweeteners, these mice also had a poorer metabolic response. We were able to show for the first time that the impact of sweeteners on the microbiome can result in a negative impact on our metabolic health. After a lot of experiments in mice, where we proved beyond any doubt that mice should not drink artificial sweeteners, we were really wondering what would be the impact on humans.

We started a study in healthy individuals, so people that are not overweight and are without diabetes. We asked them to supplement their diet for two weeks with common artificial sweeteners, so sucralose, aspartame, saccharin, or one natural non-caloric sweetener stevia, and we followed up on glucose tolerance and also on their microbiome before, during, and after the exposure to the sweetener. We saw that two sweeteners, saccharine and sucralose, had a detrimental impact on their glucose tolerance. So just during two weeks of exposure to the sweetener, they had poorer responses to glucose. That would already put them on the path to potentially developing pre-diabetes and diabetes. We saw that all four sweeteners altered the microbiome. Again, when we took microbiomes of these people and transplanted them into germ-free mice we saw that the stronger the impact the sweetener had on your microbiome - that means that you would have a poorer metabolic response when you transplant these microbiomes into mice. This was really showing that there are person-to-person differences in the responses to sweeteners, and this depends on how much a microbiome is impacted by the sweetener.

That was amazing summary in a short time of really complex and fascinating science. It's interesting that some sweeteners are having a stronger effect than others, which I guess makes more sense, because they're not all chemically alike. Is it possible to know when you get an effect on something like glucose tolerance from the use of the sweeteners, whether the microbiome is the main mechanism, the only mechanism? How does it fit in there when you start thinking about the impact of sweeteners on something like the glucose tolerance?

That is a really great question, and I think the short answer would be that we don't know for sure. There have been multiple other groups that have been studying the impact of sweeteners on metabolic health or other parameters related to our health that have found fascinating mechanisms that are not related, or at least, not directly related to the microbiome. So for sure, sweeteners can have a broad impact on our body, not just for their impact on the microbiome, but what we are seeing, actually, is that's the impact that they have on the microbiome is sufficient to produce detrimental impact on metabolic health without any other measurable impacts, at least, in our studies.

Many, many people have been using these artificial sweeteners in one form or another for many, many years, and in some cases, they're introduced into the food supply in ways that people may not even be aware of. Is there any way of knowing what happens if animals or humans have used these for a long period of time and they stop? Does whatever the impact on the microbiome reverse itself?

That's a fascinating question. In the short term, that is something that we have measured in our studies, and others have done similar works in animal models. In a study like what we have done, which is two weeks of exposure, then one week of follow-up, you see some reversion of the microbiome to what it was before the exposure to the sweetener. But we should say that these individuals were recruited to the study precisely because they're habitually not drinking artificial sweeteners, so their body saw sweeteners potentially for the first time. So then if they immediately stopped after two weeks, in that scenario, we can say that the microbiome reverts. What happens after years of exposure to sweeteners, that's a study that we're definitely interested in doing, or I would be really happy to see the results if some is already doing such a study, but I am not aware of long-term studies where people just stopped taking sweeteners and then their microbiome was profiled.

My mind is sort of firing with ideas of ways to study that question, but it's heartening to know that at least in the short term, at least some of the whatever damage is done starts to revert. That's very good news for people who have been using these products who choose to stop them for one reason or another, there may be a benefit to the microbiome. Let me ask about children. So many parents, they're concerned about the effect that the sweeteners might have on their children. Is anything known about this?

Yes, I think this is a good point in the conversation to talk about the various types of evidence that we have about the detrimental impact of sweeteners. If we look at associative studies, most of these studies would find some sort of association between drinking artificial sweeteners and a negative impact on weight or on diabetes risk. So the associative studies are, for sure, pointing to a negative impact, but they don't provide evidence that the sweeteners are causing these negative impacts. So they might be a result of, you know, the changes in weight or the risk of diabetes rather than the cause. And then when you go to studies that actually provide causality, so these would be, for example, randomized controlled trials when you give the individual the sweetener then see what happens to their metabolic health, these types of studies are all over the place in terms of benefit versus risk, both in adults and in children. So unfortunately, there is no good answer to that question. There are studies that show a risk, but even studies that show a benefit.

Even if there is risk from the artificial sweetener, some people may feel that the benefit, in terms of weight control, is more important, and they might say, "Well, I'm willing to accept the risk because of the benefit," but we've heard from others that whether these products actually help people control their weight is in question as well. What do you think about that topic?

Yes, so what you would do when you have all of these studies that show even opposing results, and you try to find the truth, you would do a meta-analysis. When you perform meta-analysis on specifically the question of impact on weight, you find a very modest beneficial impact on weight. And even then, the quality of the evidence for that impact are low. Even if there is a benefit, it's very mild, and the evidence for such a benefit are not very strong. I think that's why organizations such as the World Health Organization have recently said that this may not be the best strategy for assisting individuals to lose weight.

You mentioned that the two compounds that had the strongest effect on the microbiome were saccharin and sucralose. Is that correct?

In our study, yes.

So saccharin, I'm not sure how much that's used in the food supply still. It may be there, but it's been around forever. Maybe I'm wrong, but I figure that it's been displaced by lots of newer advances. But sucralose, which I think is marketed under the brand named Splenda, is a much more recent development in the field. It's interesting that that's having a negative effect too. So do you think that there's reason to believe that those two would be substances to avoid?

I would say that you would never want to make public health decisions based on one study. I would say that that goes both ways, I think. I wouldn't advise avoiding saccharine just based on one study, and I wouldn't say that aspartame and stevia are safe just based on one study. I would say that others have found negative impacts for aspartame and for stevia that we have not seen very strongly in our study, whereas others have found both negative and neutral, or even beneficial effects for sucralose in other studies. So I would not make recommendations based on just our own study, but considering everything that is out there, I would say that all four sweeteners that we studied, and others, including Ace K, that we have not studied in a recent human study could pose a risk for some individuals. Unfortunately, right now, we don't have any good tools of predicting who would be those individuals, so it's a question of whether people should take that risk or not.

Thank you for being appropriately cautious with the result, because as you said, the work is relatively recent, but why I'm really happy you're working on this topic. So summing this all up, what do you think is most important for people to know?

I think, at this point in the research, and just recently, another group provided really interesting evidence about a different sugar substitute, erythritol, also posing a risk for cardiovascular disease, at this point in the research of artificial sweeteners and sugar substitutes, I think we cannot say that these substances are innocuous. They can pose a risk for at least some individuals, and we and others are definitely working hard on being able to help people know whether or not they are in those risk groups. But then the question is what can people do? I think what people should definitely not do is switch back to sugar. I think that if the evidence for the impact of artificial sweeteners are still something that requires further research. I think that the detrimental impacts of added caloric sugars in our diet, in our beverages, are beyond doubt linked to detrimental impacts on our metabolic health. So people should not switch back from diet soda to regular soda, that's for sure. But we and the industry alike should find ways of reducing the intake of sweeteners, and both caloric and non-caloric sweeteners in our diet to levels that hopefully don't pose as great a risk as what we are currently consuming.

Bio

Dr. Jotham Suez is a Feinstone Assistant Professor at the Johns Hopkins Bloomberg School of Public Health. Dr. Suez's work on non-nutritive sweeteners was instrumental in understanding how these popular food additives can counterintuitively disrupt glycemic control. During his graduate work at the Weizmann Institute, he demonstrated that sweeteners are not inert and can alter the gut microbiome, and causally linked those impacts to impaired glucose tolerance. He further showed that in humans, the microbiome mediates individualized responses to sweeteners, potentially underlying the conflicting literature on their impacts. Similarly, Dr. Suez's research on probiotics offers an opportunity to resolve the contradictory literature on their efficacy. His work highlighted the microbiome’s importance in modulating probiotics colonization and downstream impacts. Inspired by these discoveries, Dr. Suez is fascinated by the potential of harnessing microbiome heterogeneity in precision medicine and personalized nutrition. In 2020, Dr. Suez received the NIH Director's Early Independence Award.

Processed food industries are thriving in developing countries, despite government commitment to eradicating non-communicable diseases, prevention programs aim at reducing obesity, type two diabetes, and sugary beverage consumption. What's more, political leaders in some countries are reluctant to regulate the marketing and sale of these products, particularly among vulnerable groups, like children and the poor. Like me, you might be asking yourself: why? Our guest today is the author of a new book, "Junk Food Politics: How Beverage and Fast Food Industries Are Reshaping Emerging Economics." His name is Professor Eduardo Gomez, Director of the Institute of Health Policy and Politics, at Lehigh University.

Interview Summary

Let's begin with a basic question, what prompted you to write the book?

Great question. It really started, I remember almost the day, when I came across this article written by the New York Times in 2016. This article started to talk about the rise in influence of the sugar industry in the US, and how they were shaping evidence about the connection between the consumption of sugar and heart disease. For many years in the past, that connection was never emphasized when it came to national dietary recommendations. This New York Times article really revealed how powerful and influential these industries were in shaping the evidence and policies on the linkages between sugar and heart disease, and our consumption of these products.

At the same time, I was doing research on obesity policy in Brazil, comparing Brazil to the US, and why Brazil was doing better in the areas of nutritional information, prevention, and awareness about childhood obesity. I also saw that obesity cases were still increasing in Brazil despite these prevention efforts. At the time, I was also starting to work in Mexico and saw similar policies in Mexico being implemented on prevention and awareness, and national dietary guidelines. But still, we saw a rise in obesity, a rise in adolescent diabetes. So those two things - the evidence about how industries manipulate data and dietary guidelines - and then how luncheon programs are really not achieving their goal of reducing childhood obesity in adolescent diabetes. Those puzzles really motivated me in writing this book to really delve deeper into this question. That really required not a journal article, but a book that would do an in-depth historical case study analysis of several countries, and to document and do interviews on how these industries are working with government. And, how government also works with industries in this area of trying to address childhood obesity, and type two adolescent diabetes.

So how did you go about collecting data for the book?

I did a qualitative comparative method, which is a bit different, as you know, from most people working in public health and epidemiological studies about childhood obesity and diabetes. That entailed a comparative historical analysis of several similar case studies. I chose cases in the emerging economies that, I think, reflected the biggest problems with obesity and diabetes in their region. But the goal of the comparison, was really to accentuate similarities between cases, and, also, the vast differences and uniqueness of the cases. I then went about doing the research through document analysis of several different sources, books, articles, policy reports, media news, talking about the issue, both in the English language, and also in the countries of Brazil and Mexico, the Spanish and Portuguese language. I did interviews with activists and researchers in several of these countries, although not all of them. I think bringing together all the different qualitative evidence was very effective in trying to thoroughly address this issue. It's a topic that has not been discussed that much. Bringing together the multiple evidence pieces took a long time.

It produced a wonderfully rich book with lots of interesting information from different sources around the world. I, for one, really appreciate what you've done. So in the book, you have very detailed case studies, as you mentioned, of a number of countries, in particular countries such as Mexico and Brazil, India, Indonesia, China and South Africa. Let's talk about a few of these countries, and then, perhaps, we can return to something that you alluded to a moment ago. That there are quite striking similarities across the countries. So what did you learn about Mexico?

I had lived in Mexico for several years doing research there, and the fast food culture and industry, and the consumption of soda, is extremely high. Compared to the US, Mexico's per capita daily consumption of soda is highest, arguably, in the world. Coca-Cola played a major role in that. Coca-Cola was in Mexico for many, many years, and the NAFTA Free Trade Agreement facilitated the arrival of Coca-Cola, and of many other kinds of ultra-processed foods and industries, into Mexico. Mexico is one of the world leaders in childhood obesity and type two diabetes. The government did, for many years, a good job of raising awareness to this issue. The National Institute of Public Health in Cuernavaca, for example, did fantastic work elevating the issue, convincing the government that something needed to be done about this ongoing health problems, especially among children and the poor.

But what I found is while there was legislation being implemented, it was, a lot of times, delayed, and those policies that were created, such as limiting the presence of sodas within schools, were not really effectively enforced. A lot of parents reporting to schools that their children were still consuming soda products. Of course, everyone knows about the soda tax that was implemented in 2014 in Mexico, becoming the first in the world to have a national soda tax. That's been a very effective effort. But there are several years in which this was debated and delayed, and for many years industries resisted improvements to the food label, which was, eventually, recently accomplished. But all of this started to point to the power and influence of major industries and their interest group.

One thing that I learned in this case is that industries also engage in several partnerships with government to try and take away the focus from regulations and improving food labels, for example. And one partnership is working with government to introduce the importance of exercise in schools. And it's something that we'll see, also, in the case of China. And so that has taken attention away, in addition to the lobbying efforts, and funding science and research sort of questions, from the efficacy of a soda tax. But one thing that was very important is that presidents also matter, and their relationships with industry. One president that really stood out was President Vincente Fox, who was a former Coca-Cola executive for the region. And that relationship facilitated industry's influence within government, and in connecting with politicians in influencing policy over years. But then later, subsequent presidents, like President Enrique Pena Nieto, worked with Nestle to address hunger eradication programs in Mexico.

So these partnerships with industry, while they are admirable in trying to eradicate hunger, they also, at the same time, bring legitimacy to these industries. This facilitates their ability to influence policy. Those was some of the key lessons that I found in Mexico.

So moving to a different part of the world, and, of course, to a different political system, what did you learn about China?

China has seen a burgeoning growth in consumption of soda, and also fast food chain establishments. We've also seen a huge increase in childhood obesity, and adolescent type two diabetes. But was really striking about this case, is that the government has done a great job, not only of increasing awareness about the challenge, but emphasizing the importance of exercise as a primary way to try and address the issue and why this particular approach. Instead of regulation limiting sales and access to foods for children and the poor, in trying to emphasize this idea of exercise. Now I found that through the International Life Sciences Institute (ILSI), Coca-Cola, and other industry, had an influence. The ILSI found partners within the Ministry of Health, who created the ISLI of China, and through these partnerships, in these connections between I-S-L-I and major health officials, the idea of emphasizing exercise as a solution started to infiltrate, and really shaped government legislation. I cite the excellent work by Susan Greenhalgh at Harvard, who documented a lot of how this was happening. At the same time, we saw industries partnering with government, and government officials emphasizing sports and exercise as an approach. But surprisingly, there was really no effort to introduce regulations on advertising and marketing. Similar to what we've seen in the US, no effective food regulations or mandates on quality of sugar and products. That really was startling, given the huge problem that China's having with childhood obesity. But again, government partnerships with industry on eradicating poverty and achieving economic growth, certainly doesn't help, and overlooks the need to introduce regulations, and sees industry as a partner in trying to achieve China's broader efforts on poverty reduction and economic development.

We're certainly starting to see some themes emerge in the stories that you're telling. So let's go to the third continent. What did you find in South Africa?

South Africa is a very interesting case, where, again, like these other countries, you've seen a rise in obesity and type two diabetes. It's been very challenging because culturally, being overweight has been seen as a sign of health for some. Being thin, being associated with diseases, such as HIV, AIDS, or tuberculosis. So, one of the major hurdles that governments, and activists, have also been trying to address, is information about the health implications of being overweight. And then also the increasing public's knowledge about type two diabetes. Similar to the other cases, you saw government efforts, beginning in 2015, to address the national obesity issue. But there are very, very few effective policies introduced, such as regulations on advertising and marketing. These have basically been introduced as plans and ideas, with no concrete efforts yet. The government relied on self-regulation, where industries pledge not to market their products to children, and to be more responsible in that. Also, there have been no regulations on sales of these foods in and around schools, and no improvements in labels. Why has that been the case? Again, industry has been very involved through policy partnerships, working with government to emphasize, again, exercise. Companies, like Nestle, have done a very good job in providing nutritional education and training to schools. While admirable, these partnerships have distracted the government from pursuing needed regulations, and trying to address these issues, seeing that these industries are partners, and seeing no real need to introduce these regulations. But again, at the same time, presidents matter. You've had presidents with very strong connections to industries. The current president, for example, having been in consulting profession, direct ties to fast food industry. And they've seen these industries as a critical partner in addressing economic development, but especially job security, and job growth, and seeing them as a need to be there in prospering. But, at the same time, you've also seen a civil society that is starting to emerge, but has been challenged by industry's relationship with other nutrition researchers and activists, and not being able to work and create a broader mobilization effort to address this issue. %he activist community is just now starting to emerge. They don't have as many allies in society that they can work with. As we saw in China, that civic activist movement has been just very slowly emerging. That's been limiting as well.

These comments, so far, are consistent across countries. Focusing on physical activity, for example, diverting attention away from industry influences and regulations that might affect them, weakening regulations, and things like that. What do you see as the main themes that are weaving through this picture?

There are several themes. One is policy partnerships - industries partnering with government, and how this helps industry convince policy makers that regulations are not necessary. Those studying commercial determinants of health and nutrition, we all know this, but this has been especially prominent in the emerging economies. Another, is corporate social responsibility activities. There have been so many cases, wonderful efforts, that major soda and food industries are doing to increase education, nutritional awareness and training, even food regulation, and quality of food For example, with street vendors. But again, these CSR activities are taking away, and distracting from the need for regulations, while, at the same time bringing legitimacy, and social legitimacy, community legitimacy, to their product. Another major theme is that these corporate social responsibility activities, for example, sponsoring or providing support to NGOs, that contributes to dividing society. So, when industries partner with certain activists, or NGOs, that question the importance of particular policies, or libertarian principles, of having the right to eat whatever food that you want, whenever industries partners with these researchers and activists, it takes away from the number of activists, real activists, working on the issue can partner with. There are many cases where I interviewed activists are saying that, they don't have as many allies that they can work with, because of these other people. These nutrition researchers working with industry. So that was a major issue that came across. Another was institutions. Institutions matter very much, specifically, their ability to include civil societal interest in ideas. In the case of Brazil, I talk about Consell, a national council that was within the office of the presidency. And under the previous Lula administration, civil society had access to the office of the presidency in providing nutritional information, and recommendations for policy. Under the Bolsonaro administration, the Consell Institution was no longer present. But now it has reemerged again. That was the one case where institutions really mattered in guaranteeing access to activists. In all the other countries, these kinds of institutions were not present. A final theme is that presidential politics and policy matters considerably. We often point the finger to industries, you know, blaming them for everything, but this book really shows that we also need to blame presidents for not being more careful in the kinds of partnerships they engage in with industries. Even though their intentions may be admirable in trying to eradicate hunger, eradicate poverty, achieve economic job growth, by partnering with soda and food industries, they're also providing legitimacy to them, and providing excuses, not really to pursue regulations that may harm their prosperity. Those were the main themes that came out in the book.

So a number of things have been tried around the world to counter industries influence. What do you think are some of the most promising?

The most promising are effective regulations on advertising and sales of products. And there are very, very, very few great examples, but one, Chile, has seen amazing progress in introducing restrictions on the advertising of foods, by law, eliminating the usage of cartoons on cereal boxes, something that, of course, we haven't achieved yet in the US. That's been very effective in addressing this issue. I think that these sales and advertising regulations are just the most difficult to achieve, but can really get to the root of the problem, which is decreasing children's awareness, and interest, in food products. Another is incorporating civil society within institutions. The more the governments can provide a venue for activists to have presence within the Ministry of Health, and to actually introduce policy ideas, that can be very effective. I think that that's been, with the exception of Brazil for several years, absent in all of the countries that I looked at in my book. I think that's something that needs to really be taken more seriously. And then another, is investing in civil society, providing more funding for nutrition researchers, activists, and NGOs, that are trying to raise this issue about childhood obesity, but also the commercial determinants of health. That is still much needed area. The Bloomberg Foundation has done great work in Mexico, but we need a lot more in other emerging economies, and lot more support for these activists. These are efforts that can really help to address this issue.

I'm happy you mentioned the Bloomberg Foundation, because, thanks to them, a number of these things have been evaluated, which really helps other countries be informed about what might be effective, and on what might not be. Are there things that are not being done that you would think might be considered?

I do think that it's time that presidents around the world, and other health officials leaders, question their partnerships with industry. Question if it's really effective. I believe that there should be more of an effort to not have industry involved in nutrition policies, non-communicable disease policies, and, especially, policies that focus on childhood obesity. I think the case of China really showed that that can be a major problem. I think that one, political leaders need to take more leadership in reevaluating the effectiveness of these partnerships, and if they're appropriate. Another is that laws on regulations of conflict of interest need to be well established. Really, in none of the cases that I looked at are there federal laws and regulations on if industries can contribute money to nutrition conferences, sponsoring of nutrition conferences. In Brazil, they are now starting to address this, but in other countries, this has not really been addressed yet. This is unacceptable when there are industries that have conflict of interest, and are supporting nutrition scientists and researchers. One of the things that really needs to be done is increasing government, or foundation, support for nutrition scientists in these emerging economies, so they are not interested in working with industry. Finally, there just needs to be a lot more of a government commitment to civic inclusion in these kinds of policies. We all know the civil society matters. Of course, government officials will always say, of course, you know, we're listening to civil society. But the evidence on to what extent activists have access to national institutions and policy, is very, very scarce. I'm just not convinced that governments are doing enough to include activists into their national policy discussions in these emerging economies. With the exception, I think, of Mexico, now, hopefully, with Brazil, the other emerging economies that I talk about in the book really have not achieved, and I think that needs to be addressed. These are the issues that really need to be addressed going forward.

Bio

Dr. Eduardo J. Gómez is an Associate Professor and Director of the Institute for Health Policy and Politics at Lehigh University. A political scientist by training, his research focuses on the politics of global health policy, with a focus on emerging middle-income countries. He is the author of three books, the latest being Geopolitics in Health: Confronting Obesity, AIDS, and Tuberculosis in the Emerging BRICS Economies (Johns Hopkins University Press, 2018). Dr. Gómez has published his research in a myriad of peer-reviewed journals, as well as policy journals and major news outlets. His new book, Junk Food Politics (Johns Hopkins University Press, 2023), critically examines the rise and political influence of soda and ultra-processed food industries in developing nations, with a focus on NCDs among children and the poor. He is also leading several other major research projects focusing on the politics of NCDs, such as type-2 diabetes and obesity, in Mexico, Brazil, and Indonesia. Dr. Gómez is also a Commissioner for the Rockefeller Foundation and Boston University Commission on the Social Determinants of Health. His research has received external funding support from the Rockefeller Foundation, Oxfam, George Soros, and Tinker Foundations.

Prior to his arrival at Lehigh, Dr. Gómez was an Associate Professor (UK Senior Lecturer) at King’s College London, Assistant Professor at Rutgers University, and pre-doctoral visiting scientist at the Harvard School of Public Health. He has also previously worked for the RAND Corporation, the World Bank, and the Inter-American Dialogue. Dr. Gómez is also a veteran of the United States Air Force and is a former Term Member of the Council on Foreign Relations. He received his PhD political science from Brown University, MA in International Relations from the University of Chicago, and BA in Foreign Affairs from the University of Virginia.