Illustrations by Jacob Waites

Food Equity, Health, and Inclusive Innovation: A Conversation with Nancy Roman

This interview series is part of First Mile Health, a collaboration between IDEO, Robert Wood Johnson Foundation, and Building H to imagine how we might design health into everyday life.

Joanne Cheung
Jan 19 · 7 min read

The food system is not broken, it’s designed with inequity as a built-in feature. The key to creating more equitable food systems lies in igniting innovation in systemically overlooked places: the places where people have the fewest resources, the lowest incomes, and the least choice.

In this interview, I speak with Nancy Roman, President and CEO of Partnership for a Healthier America, to learn about her latest initiatives to “build the ladder from free to affordable” and ultimately, create a market for food equity.

Joanne: Given your experience, what are the biggest barriers that get in the way of people eating healthy?

Nancy: It’s important to understand that in the food space, the barriers are different across the socioeconomic spectrum. At the top of the socioeconomic spectrum, the primary barrier to eating well is time: you have sixteen meetings back to back, so you’re eating snacks out of your drawer. For most of the rest of the country — the bottom of the socioeconomic pyramid — their barriers are many. Time is one of them, but more important are access and affordability.

I’ve also come to think of marketing as a barrier. By nature, we crave salt, fat, and sugar, and the advertising industry has figured out that it’s a lot easier to manipulate your taste buds around salt and sugar than to inspire you to eat a salad. A disproportionate share of advertising revenue goes to junk foods, and I think junk food marketing is one of the biggest barriers for low-income individuals, and then lack of access to healthy food.

Now, because it’s been so sustained over decades, it’s really become a generational problem. The culture has lost the habit of eating produce and cooking meals. The culture is purchasing fast food, which is perceived to solve the other barriers: time and lack of access.

Innovate for everyone

Joanne: Are you seeing any cultural changes due to the pandemic that may lead to changes for the next generation?

Nancy: I think one of the positives coming out of COVID-19 is how it revealed the gross inequity and fragility of the food system. Our just-in-time supply chain broke down in spectacular fashion early on, resulting in shortages in the grocery stores and tons of produce going to waste. I think there’s a real desire now to have a base of food within striking distance that doesn’t rely on a global supply chain.

That’s what we’re doing with our work now. We’ve created the COVID-19 Fresh Food Fund, which just launched in Colorado and New York. Families have access to fresh produce boxes for free or at a reduced cost. In the short term, it’s solving a critical problem: we hired furloughed workers to rescue produce from the composter to give it to families in need. But the bigger thing is, we’re collecting data on things like willingness to pay so that we can work towards affordable access. [The lack of] affordable access is the thing we’ve got to solve.

I keep saying to my staff and my peers in the space: this is our moment.

The current system is revealed to be flawed, and I’m saying, let’s build what we want.

It’s a really big job, obviously, that’s beyond the Partnership for Healthier America, but we’re using our resources to try to run this COVID-19 Fresh Food Fund in a way that gives data that we’ll use to incentivize innovators to come in at affordable price points. One of the things that drives me crazy is that innovation always stops at the top of the socioeconomic pyramid. Once in a while, you get enough volume that the price comes down and it becomes more accessible, but usually not. Fast Food chains were once an innovation for the people of means, and then it became everyman’s food. The ultra-processed carbs very quickly found their way down. Now we’re recognizing that ultra-processed isn’t good for you, but it’s hard to scale the things that aren’t ultra-processed at affordable price points. That’s really where we need innovation.

Joanne: What kind of impact have you seen from the COVID-19 Fresh Food Fund so far?

Nancy: I just read a message from the person delivering [produce] in Denver that said, “These families are crying because it’s been so long since they’ve had a piece of fruit or any fresh produce like this.” In food banks, we’re usually getting produce on its last legs. Of course, you always want to distribute with dignity, so we would never distribute anything rotten, but it’s not always gorgeous. This produce is fabulous. It’s the best way to expose people, and we’re also gathering data on willingness to pay because this box is worth about $50. At the end, we’re going to say, Would you be willing to pay $5 for the box? $10? Because the world can’t be everybody giving out free food forever. We have free food from food banks, and then we have beyond-reach food up here. How do you build the ladder from free to affordable?

Learn through iteration

Joanne: How has Partnership for Healthier America evolved over the years as the organization iterated and learned?

Nancy: Our mission used to be ending childhood obesity within a generation. We changed that, and our vision is now that children grow up healthy — free from obesity, diabetes, and all these chronic diseases. Our mission is to transform the landscape of food in pursuit of health equity. We’re trying different things now, and we’re thinking much more broadly about corporate engagement.

Joanne: What about how you measure success? Has that changed over the years?

Nancy: I’m a big metrics person, so I measure everything. We’re actually changing what we’re measuring at Partnerships for a Healthier America: we used to measure calories that we’re taking out of the marketplace, and we’re now measuring portions of healthy servings that are reaching people in need. It’s like a hunger heat map; you can see how we’re putting our partnerships in zip codes where they’ll have an impact.

Joanne: Data seems to play a critical role, both for iterating on the program and for catalyzing action.

Nancy: I think designing data is huge. You have to be super clear about what you want and not be naïve, especially gathering data among low-income populations. You have to have a backup system — you can never just throw a survey in a box and hope people take it — and of course, you have to be scientifically accurate, clean, and careful. Your data is better when you repeat it city to city. You learn, you iterate, and you improve as you move to the next city.

For example, for me, success coming out of the COVID-19 Fresh Food Fund will be high-quality data about produce that people prefer, their habits, how often they eat it, and what they would be willing to pay for that produce. If I get that high-quality dataset, then that partnership is a big success. There’s all this collateral good being done, but the data is the success for me in this instance.

Learn from failure

Joanne: I’d love to learn more about your leadership philosophy. What drives and inspires your work?

Nancy: One thing that might differentiate me from other leaders is that I have a high tolerance for both risk and for failure. I’m willing to try a lot, and I’ve probably failed more than most people, but I’ve also had more success than most people.

Joanne: Failure is widely recognized as important, but can be so emotionally challenging. Do you have any advice for getting comfortable with failure?

Nancy: Part of what makes me more comfortable with failure is that I see the learnings as a huge success even when I fail.

I’ve never had a project that has been a complete and total failure because I’ve never had anything that I didn’t learn a lot from.

If you’ve got a string of things that didn’t go all the way but that taught you something big that got you on to the next step, at the end of the day, it doesn’t look like a record of failures. It looks like a record of up.

The key is not to be afraid of it. I work really hard to succeed, but when a project doesn’t work out exactly like you want it to — and hardly any work out exactly like you want — you’re adapting your expectations and tweaking as you go. It’s actually sort of fun.

Joanne: What a great recommendation, especially in this time when it seems like the world is failing. I’m sure we’re also learning a lot.

Nancy: This is a hinge moment. It’s a scary moment, but I think this will be one of the big moments that reposition society. There’s been a lot of destruction, but there’s just a wide-open field of opportunity. It’s a perfect time to be doing what you’re doing.

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