Institutional policy change to promote health and sustainability through food.

Abstract

The rising price of food in the global market place, food safety scares, concerns about peak oil, concerns about coming grain shortages, and the poor diet of the average American have brought healthy and sustainable food to the forefront of US food policy debates. In the US, some two-thirds of adults are managing the negative consequences of overnutrition, including premature death from heart disease, diabetes, and some forms of cancer (1, 2). The US adult diet has shifted so that the average adult consumes about half of their meals away from home (3) and an increasing proportion of calories from sugar-sweetened beverages (4) and salty and highly processed snacks (5). The negative environmental impact of this dietary pattern is estimated to be five times that of the environmental impact of a dietary pattern from organically-produced foods or a plant-based diet (6). In this context, most foods eaten in the US are prepared by people who are not members of the same household, with food and ingredient choices being made by businesses and other institutions. Therefore, institutional policy designed to improve access to nutritious food holds great promise. Policy design is a process in which potential policy instruments (e.g., guidelines, regulations, or incentives) for social problems, such as poor nutrition or environmental degradation, are identified, advocated, and adopted (7). To change food practices at institutions such as private corporations or government agencies, policy design can either be initiated by the institution or by decision-makers external to the institution. To be effective in attaining the goals described in a policy, the design needs to be a good fit for the policy context (8). Thus, institutional food policy change, whether initiated internally or externally, should seek to improve health and sustainability, recognizing that, for most Americans, much of their food is selected and prepared outside the home. Potential food policy change should also take into account the institutions’ constraints and commitment to changing its food practices. In this supplement, two important policy developments for healthy and sustainable food service practices are described. These policy strategies represent what appear to be very good fits for the current political context. They focus on institutions and communities. They leverage the purchasing power of institutions to create demand for healthier and more sustainably produced foods. In the first paper, the process of developing food service guidelines is described. These guidelines, adopted by Health and Human Services and Government Services Agency, allow contracting officers to prefer healthy and sustainable foods when making their selections. The second paper describes farm-to-institution programs that link local producers and the purchasing power of local institutions, such as schools. In the discussion section of each paper, evaluation of the intended and unintended consequences of each policy strategy is described. While these policy designs are promising, additional action will be needed to shift dietary practices in the US. Food company policies and decisions are just as important and may even be more influential. Recent bottled water policies are illustrative (9). Bottled water was first marketed in the US to elite consumers as a health and fashion symbol. Citizens in communities where bottled water companies were drawing water from aquifers became concerned about conserving local water supplies and environmental advocates focused on the unnecessary use of plastics, making bottled water less appealing to these elite consumers. More than one hundred cities banned the sale of bottled water in certain venues because of citizen concerns over local water conservation and environmental impact. Bottled water companies responded to these bans by lowering prices and launching new marketing campaigns to stabilize sales without substantially changing the product or production methods. The marketing focus also changed to increase urban sales by increasing urban consumers’ concern over the health and safety of municipal water supplies. It is possible (or even likely) that private corporations will respond to institutional policy change in a similar way, including initiating new marketing strategies, lower prices, promotions, and targeting other groups. For instance, the Health and Sustainability Guidelines might reduce the demand for trans-fat in one market (e.g., government employees working for federal agencies), and companies might respond by marketing and promoting trans-fat foods to other segments, including in less empowered and protected populations. Changing food company policies regarding questionable ingredients or practices may require more than regulations that affect only one of their markets. In the context of new Health and Sustainability Guidelines for institutions and farm-to-institution strategies, two areas of policy development are needed to advance the goal of improving human nutrition and reducing environmental degradation in the US. These include: continued local organization and coalition building to create local policy change, and federal government policies that direct institutional practices. The following examples describe these three policy strategies. Coalition building Large school districts nationwide are exploring new procurement strategies to bring more healthful, regionally sourced and sustainably produced food to school cafeterias. Led by School Food FOCUS, a national collaborative that works with school food service leaders, school district partners, and policymakers to achieve these goals, dozens of districts are demanding more healthful foods from manufacturers. Examples to date include flavored milk with less sugar, higher percentages of whole grain in bread and whole-muscle chicken produced with fewer or no antibiotics. Peer-to-peer communication among districts and vendors has helped to create more demand for these products. Eventually, these practices may become part of new institutional bids or new local food policies. Future federal government policies to direct institutional practices Additional institutional policy development can continue in many directions. We focus on one critical insight from the private corporation perspective here. Current Health and Sustainability Guidelines focus on what foods will be offered to a relatively narrow group of people, employees of government agencies. The strategy recognizes the power of purchasers, such as government cafeterias, to negotiate a contract for what foods are served to their employees but ignores the power of purchasers to demand similar standards for the food the company sells to all of its customers. In other words, government purchasers could demand higher standards than are currently exercised through Health and Sustainability Guidelines. Currently, federal policy related to nutrition has focused on providing guidance to consumers and to some institutions, such as schools and daycare centers, about what foods can support health. Other policy issues, such as labor practices and environmental protection, have effectively shifted overall business performance to meet social goals. These policies require that companies implement desired practices throughout their operations in order to be eligible to do business with federal government agencies. Given the relatively small lever provided by direct federal spending, this approach may be another effective strategy to improve the public health and environmental sustainability of the nation’s food system.