Critical Thinking on Health Equity & Food Systems: 8 Policies
Nessia Berner Wong, Katie Hannon Michel, and Kimberly Libman
Developing and implementing effective food policy requires critical thinking to avoid unforeseen negative consequences or missing strategic opportunities to promote health and equity. To help readers develop a critical perspective on food policy, this blog post discusses 8 policies with outcomes that fall along a spectrum of impact. Some of these policies have had harmful outcomes or are contrary to current research and evidence; some have both positive and negative outcomes; and some are examples of success with potential for negative consequences.
Policies that have harmful outcomes or contradict research
1. SNAP Work Requirements
SNAP is one of the most widely used food assistance programs in the nation and has positive impacts on children, youth, and families. But, as discussed in the second blog post in this series, the program is underfunded and its accessibility is being further threatened by more stringent work requirements being debated in the 2018 Farm Bill. Such changes, promoted as a measure to help people in poverty become self-sufficient, would severely limit the reach of SNAP by reducing participation and would legitimize myths about poverty that are harmful and not supported by public health or social science research.
More stringent SNAP work requirements would exacerbate poverty and inequality, increase administrative costs for states, shift the burden of public assistance to state and local governments, and increase costs overall as people experience the health effects of losing SNAP benefits. Limiting SNAP eligibility means that income that was dedicated to other needs must shift to cover food costs, reducing resources that allow people to live in safer homes and neighborhoods, access health care, buy healthier food, have more time for physical activity, or generally experience less stress from trying to make ends meet. SNAP participants already experience a greater burden of diet-related disease and have far less wealth or savings to fall back on in times of need, exacerbating the effects of a loss of benefits. Ultimately, limiting access to SNAP by imposing expanded work requirements is a shortsighted “solution” to poverty on the part of policymakers. In the long run, it will lead to greater health inequity and greater societal expenses as people suffer the health consequences of a loss of benefits.
To learn more about how limiting access to SNAP is harmful to health equity, check out the Center on Budget and Policy Priorities’ resources and publications on food assistance.
2. Minimum Wage Exemptions for Food System Workers
One of the fundamental purposes of the Fair Labor Standards Act (FLSA) is to establish a national minimum wage, which is currently set at $7.25 per hour. That standard does not apply to all workers in the same way, however. Tipped workers — including millions of restaurant servers across the country — do not receive the same basic federal wage protections as workers in other industries. Specifically, the FLSA allows an employer to pay a tipped worker direct wages of only $2.13 per hour as long as the amount the worker earns in tips — known as a tip credit — brings his or her total pay up to the federal minimum. If tip earnings are insufficient to meet that standard, employers must make up the difference. Although many cities and states have increased the local minimum wage above the federal level, most laws have not raised or eliminated the tipped wage. In fact, all but 7 states maintain a subminimum wage for tipped workers.
A quarter of full-time restaurant servers earn wages that are below the poverty threshold for a family of 3, and 50% do not earn a living wage for a family of 4.
Tipped workers are nearly twice as likely to live in poverty as non‑tipped workers. The food service industry is not immune to this trend: Although some servers work in high-end restaurants where they earn significant tips, they represent a minority of all tipped restaurant workers. In 2017, the median hourly wage for restaurant servers nationally was $10.01 even accounting for tips. The majority of those workers are women, who comprise 68.5% of all tipped waiters and bartenders in the United States. Of those, 16.4% are single parents. A quarter of full-time restaurant servers earn wages that are below the poverty threshold for a family of 3, and 50% do not earn a living wage for a family of 4 — one that would allow them to meet their basic needs like food, housing, transportation, and child care. Not only are servers’ earnings low, they are also undependable: Tip earnings can fluctuate from week to week, and may be influenced by factors like race, gender, age, and physical attractiveness. Further, tipped workers are at high risk of exploitation and abuse by employers and customers, ranging from sexual harassment to wage theft.
Studies have found that in the 7 states where all workers must be paid the regular minimum wage, tipped workers have higher overall earnings and are less likely to live in poverty. Income security is a key driver of health; it is correlated with lower rates of chronic disease and increased ability to access essential resources. Improving wages for tipped workers is therefore directly related to the health and well-being of the millions of workers who depend on tip-earning jobs to support their children and families.
To learn more about the links between income and health, check out the American Public Health Association’s policy statement “Improving Health by Increasing the Minimum Wage.”
3. Supermarket Restrictive Covenants
When a supermarket closes, nearby residents may find that the vacated site remains empty for many years, leaving them without convenient access to healthy, affordable food. This phenomenon often has nothing to do with local economic conditions but rather is the result of a restrictive covenant — ie, a deed clause that limits how a property may be used. More specifically, when a supermarket decides to sell its property, it is common industry practice to put a deed restriction in place that prevents competitors from moving in for a defined number of years — or sometimes even for decades into the future. The intent is typically to protect the seller’s market share by encouraging consumers to shop at another branch of its own (possibly higher-priced) chain farther away. In this way, restrictive covenants can effectively give one major grocery store a monopoly on food sales in a particular neighborhood or region.
The impacts of supermarkets’ restrictive covenants vary, depending on context and sociodemographic factors. Consumers with access to a vehicle may be relatively unburdened by the departure of a grocery store. Low-income consumers, however, are more likely to rely on public transit, walking, biking, or a ride from a friend or family member to do their food shopping and may face added stressors in terms of time and transportation costs if they have to travel greater distances to get to a supermarket. The burden may be especially great in rural areas without public transportation options. The potential adverse impacts of restrictive covenants extend beyond food access: When restrictive covenants prevent other grocery stores from moving in, neighborhoods also lose the jobs and tax revenue that grocery stores generate. Moreover, other types of businesses may struggle to make use of a vacant retail parcel that was originally designed for a supermarket, meaning that a neighborhood doesn’t lose just the economic benefits of a grocery store but the economic benefits of any business.
One possible solution to the problem of supermarket restrictive covenants is adopting legislation to prohibit them. Chicago became the first US municipality to pursue such a strategy in 2005 when it adopted an ordinance that severely curtails supermarkets’ ability to use restrictive covenants in an anti-competitive manner. Both Madison, Wisconsin, and the District of Columbia have followed suit with similar legislation. Policies like these that promote nearby access to supermarkets likely will not, on their own, motivate healthier food choices or address the fundamental drivers of food insecurity, such as lack of access to secure, well-paying jobs and affordable housing. Nevertheless, removing a legal obstacle to bringing grocery stores into neighborhoods that have historically been denied services can be part of a broader strategy to address these complex issues.
To learn more about how proximity to a supermarket may (or may not) influence food choices, check out the USDA Economic Research Service’s article “Recent Evidence on the Effects of Food Store Access on Food Choice and Diet Quality.”
Policies with both positive & negative outcomes
4. Food Safety Modernization Act Regulations
In 2011, the Food Safety Modernization Act (FSMA) was signed into law with the intent of decreasing the incidence of food-borne illnesses among consumers. Its passage came on the heels of a string of food safety failures — half a billion eggs recalled for salmonella contamination, a myriad of peanut product issues, and E. coli–contaminated spinach, to name a few. Legislation like FSMA can protect consumers from food-borne illnesses by regulating how products are grown, packaged, and refrigerated and how processors handle them. While food safety laws do protect consumer safety and health, such sweeping national legislation also has the potential to negatively impact the livelihoods of small producers as they try to comply with new and complex regulatory requirements.
Large, industrial farms and processors have the resources and capacity to comply with increased regulation and reporting requirements. Although FSMA includes exemptions for the smallest producers (determined by revenue thresholds) and has tiered requirements for producers at each revenue threshold, compliance can be very costly at the bottom of the tier. About 35% of all farms in the United States fall under the “very small farm” threshold, for whom compliance with FSMA is estimated to cost 6% of annual sales. This number may seem small, but the average income for farmers in 2011 was only 10% of sales. Thus, the cost of compliance could eat up over half of a farmer’s profits. Such a web of regulation can be hard to navigate and can force a decision between growing an operation and going out of business.
Although evaluation of the implementation and impact of these regulations is still in progress, it is important to recognize that what’s good on an individual and biological level of health can also be unhealthful at an upstream social determinants level. The burden of compliance can have significant consequences for producers’ income and the health of local economies. Such considerations make the issue and policy landscape of food safety difficult to navigate, but they are an integral piece of the discussion in any policymaking process.
For more information on FSMA and its impact on producers and consumers, visit the National Sustainable Agriculture Coalition’s website.
5. Mobile Vending Regulations
Mobile vending can be defined as selling food out of any portable vehicle, such as a truck, cart, trailer, roadside kiosk, or stand. Mobile vendors are economic drivers and job creators: In Los Angeles County, for example, mobile food sales generate an estimated $100 million in annual income, stimulating almost $160 million in upstream economic impacts, including increased sales and employment in businesses that supply vendors with ingredients and equipment. Mobile vending also provides an accessible opportunity for low-income people and immigrants to make a living and build a business. Further, mobile vendors can increase food access in underserved neighborhoods and rural areas where choices are limited or where zoning precludes development of retail food establishments.
Policies that criminalize street vending place a particularly heavy burden on undocumented immigrants, as interactions with the police may increase their chances of being detained and deported.
Cities have a reasonable interest in regulating mobile vendors to ensure food safety, prevent pollution and congestion in public spaces, and incentivize healthier food environments. In some jurisdictions, however, mobile vending regulations may stifle economic opportunities or have the potential to be inequitably enforced. Common regulations include proximity bans, which prevent food vendors from operating within a certain distance from brick‑and‑mortar restaurants; time constraints, which limit the amount of time a vendor may park and operate in one location; and technical requirements about how or where a license must be displayed. These types of regulations limit vendors’ access to popular business districts and make it challenging to stay in one place long enough to make consistent sales. What’s more, these regulations put mobile vendors at risk of civil penalties, including regressive fines — sometimes as much as $500 to $2000 per violation — and loss of business licenses.
Even more onerous than these time, place, and manner restrictions are policies that ban mobile vending altogether or make unlicensed vending a crime. New York City, for example, capped mobile vending permits at approximately 5000, fueling a black market permit trade and pushing many vendors to sell without a permit — conduct that exposes them to misdemeanor charges punishable by a $150 to $1000 fine, up to 3 months of jail time, and seizure of their goods and vehicles. Street vendors in Los Angeles won a victory in 2017 when the city council adopted an ordinance that removed criminal penalties for sidewalk vending, but because of loopholes in the law, park and pushcart vendors are still at risk of criminal enforcement. Policies that criminalize street vending place a particularly heavy burden on undocumented immigrants, as interactions with the police may increase their chances of being detained and, potentially, deported by US Immigration and Customs Enforcement. Cities should therefore consider mobile vending regulations carefully, to avoid unfair or negative impacts from enforcement activities.
To learn more about how to promote fairness and balance stakeholder interests when designing mobile vending regulations, check out the National League of Cities’ report Food on Wheels: Mobile Vending Goes Mainstream and a report by Jessica Huey at Harvard University’s John F. Kennedy School of Government, On the Go: Insights into Food Truck Regulation.
Successful policies with potential negative consequences
6. Sugary Drink Taxes
Taxes that increase the price of sugary drinks can help to nudge consumers toward healthier options. For example, research has shown that a 10% increase in sugary drink prices would result in a 12% decrease in purchases. For this reason, among others, a growing number of local governments have passed laws imposing per‑ounce taxes on sugary drinks as a strategy to address increasing rates of diet-related health conditions like type 2 diabetes, obesity, heart disease, and tooth decay.
There are strategies that can provide a counterweight to the regressivity of sugary drink taxes.
Although taxes that increase the price of unhealthy beverages can be effective public health tools, they also have drawbacks. Chief among these is that sugary drink taxes are regressive, meaning that low-income families will pay a greater proportion of their earnings toward such taxes than families with higher incomes. For example, one study found that a nationwide tax on sugar-sweetened beverages “would impose more than four times as much burden, relative to income, on households in the bottom fifth of the income distribution as those in the top fifth.” The regressive effects of sugary drink taxes hit people of color the hardest: African Americans and Latinos are more likely to consume sugary beverages than whites, a trend that may be reinforced by beverage companies’ targeted marketing to people of color. As a result, some argue that sugary drink taxes risk stigmatizing consumers and place a disproportionate amount of blame and burden on the poor and people of color instead of penalizing the beverage companies that engage in predatory marketing tactics and profit from the sale of unhealthy products.
However, there are strategies that can provide a counterweight to the regressivity of sugary drink taxes. First, government actors can engage the residents who will bear the greatest tax burden in the process of developing and implementing their tax proposals. Such a strategy may help to build trust and understanding on both sides, especially if information is shared about sugary drink taxes’ potential to generate health benefits and associated cost savings for vulnerable populations that experience the highest rates of diet-related disease. Second, governments can dedicate the revenue from sugary drink taxes to programs and services that benefit those same disproportionately burdened residents. Several municipalities are already pursuing strategies like these. The sugary drink tax ordinance in Oakland, California, for example, established a community advisory board to make recommendations to the city council on how the tax revenue should be spent. The board holds regular public meetings and gathers input from groups like the Sugar Freedom Project, which is dedicated to lifting up the experiences of those who are most affected by the implementation of the tax. To identify funding priorities and potential inequitable outcomes from Seattle’s sugary drink tax proposal, the city convened stakeholder meetings and analyzed the legislation, using the Race and Social Justice Initiative’s Racial Equity Toolkit.
To learn more about policies designed to decrease consumption of sugary drinks while also promoting equitable outcomes, check out ChangeLab Solutions’ Sugary Drink Playbook (updated version to be released in Summer 2018). A variety of tools can assist with equitable policy design; in addition to the Race and Social Justice Initiative’s resource mentioned earlier, the Government Alliance on Race and Equity has created the Racial Equity Toolkit: An Opportunity to Operationalize Equity.
7. Smart Snack Requirements in Schools
In 2010, The Healthy, Hunger-Free Kids Act established Smart Snacks, nutrition standards for competitive foods — foods and beverages sold on a school campus during the school day that are not part of the federal reimbursable school meal program. Thus, the 2010 legislation expanded the scope of school nutrition programs beyond meals served in the cafeteria. On the surface, these requirements are a great addition to the school food environment that children are exposed to every day. But in implementation, the requirements created a loophole that can be harmful in the context of the wider food environment that children are exposed to outside of school.
Low-income children and children of color are frequently targets of unhealthy food and beverage marketing, while their families often have less available capital to make healthy decisions about food purchases.
When Smart Snack guidance was implemented, the food industry quickly pivoted to meet the new requirements, reformulating their products to meet the new limits on the amount of calories, sodium, sugar, and fat allowed in competitive foods and beverages. School vending machines and snack bars were stocked with whole-grain granola bars, sugar-free canned drinks, and low-sodium chips. But these products are often packaged to look like branded products available outside of school, in the grocery or corner store, which are not subject to any nutrition standards. The presence of such copycat or look-alike products can limit the positive effects of the Smart Snack standard by making it difficult for children and families to apply behavior changes developed around food in school to food purchases away from school. A recent study showed that parents and students struggle to distinguish between healthier products sold in schools and less-healthy versions of the same brand sold in stores.
Food companies use reformulated look-alike products in schools to market their products, to the detriment of young people’s health. Look-alike products create a challenge for those navigating a heavily marketed food environment, a challenge that undermines nutrition education efforts by schools and may have a disproportionate effect on the same populations that are disproportionally affected by diet-related disease. Low-income children and children of color are frequently targets of unhealthy food and beverage marketing, while their families often have less available capital (in terms of access and income) to make healthy decisions about food purchases.
To learn more about look-alike snacks in schools, visit the UConn Rudd Center for Food Policy & Obesity’s website.
8. Institutional Food Procurement
Large institutions — like government agencies, schools, and hospitals — purchase food and drinks in large quantities every day. In the last decade, we’ve seen an exciting trend in the use of institutional procurement policies that leverage the buying power of institutions to improve community wellness via healthy, nutritious food and beverages. School districts, hospitals, and local governments have implemented policies that set nutrition standards for food and beverage procurement. Improving the diets of institution staff and the public has great benefits; healthier diets alone could prevent an estimated $71 billion per year in medical expenses, lost productivity, and lost lives nationwide.
That said, focusing solely on the nutritional value of procured foods could still have unintended negative consequences. Is the workplace safety and wage law compliance record of suppliers taken into consideration? What about the environmental footprint of certain products? Do purchases and contracts support local, minority-owned, and women-owned businesses? Procurement is a great way for institutions to exercise their “market participant” power, and they can use their purchasing decisions to influence not only health and nutrition but other contributors to health equity as well. Purchasing decisions based on a combination of good food values such as good nutrition, local economic development, fair labor practices, sustainability, animal welfare, and diverse businesses provide multiple ways to support a just food system. None of these values are more important than another, but taking them into consideration helps large food buyers ensure that they are interacting positively with health equity at multiple points within the food system. A comprehensive strategy of equitable procurement directs institutional dollars back to communities, both on the supply side (as a purchaser) and on the demand side (as a provider of food away from home).
To learn more about equitable procurement and to access policy guides and tools for implementation, visit the websites of ChangeLab Solutions and the Center for Good Food Purchasing. And don’t forget to tune in for the rest of Episode 3 of the Building Healthy, Equitable Communities Series, featuring experts who will discuss equitable procurement in more depth.
This piece is part of the Building Healthy, Equitable Communities Series and is the third of our policy posts exploring the often unexpected ways that laws and policies can help — or hinder — community health. Take a deeper dive into the topic of food systems through archived recordings of the companion webinar and conversation with an expert panel.
Nessia Berner Wong, MPH, is a senior policy analyst at ChangeLab Solutions, focusing on food systems, including equitable procurement, healthy vending, and federal food policy. Prior to joining ChangeLab Solutions, she spent 5 years at the US Department of Agriculture’s Food and Nutrition Service.
Katie Hannon Michel, MELP, JD, is a legal fellow at ChangeLab Solutions who works to support sustainable communities, with a focus on healthy and just food systems. Before joining ChangeLab Solutions, Katie served the Maine Supreme Judicial Court for 2 years as a law clerk to the Honorable Jeffrey L. Hjelm.
Kimberly Libman, MPH, PhD, is a program director at ChangeLab Solutions, where she leads the organization’s work on food policy. Before joining ChangeLab Solutions, she worked at the New York Academy of Medicine as director for prevention and community development.