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Three current policy issues demonstrate the benefit and necessity of considering health and agricultural concerns simultaneously. An example of the potential influence health and agricultural policy leaders can have when they advocate around their shared interests is the growth of farm-to-school programs. The debate over including sustainability concerns in the Dietary Guidelines for Americans illustrates how public health voices can lead to new public understanding and engagement on food production and sustainability concerns. Lastly, the issue of antibiotic use in food animal production demonstrates the need for public health organizations to work with agricultural experts to move forward health-protective solutions. These policy issues are at different maturation stages, and we cannot predict how any of them will conclude.
Together, however, they serve as a window onto a new policy environment presenting fresh opportunities for advancing the public’s health.
Farm-To-School Initiatives
Farm-to-school programs purchase food from farmers within the local area as a two-prong strategy to provide both healthier school meals for children and economic security to farmers. Many participating farmers operate small and medium-size family farms struggling to survive in a global economy. Farm-to-school programs commonly also include education about food production, nutrition, and gardening, to encourage consumption of fruit and vegetables.
Evidence suggests that farm-to-school programming improves children’s fruit and vegetable consumption, although larger and longer-lasting studies are needed. One review found that across studies, the estimated increase in fruit and vegetable consumption from farm-to-school programs, including garden-based curricula, ranged from 0.99 to 1.30 servings per day. The studies also showed improved student knowledge and awareness about food and nutrition, and more openness to tasting different foods.
There are, of course, challenges to address with farm-to-school programs, particularly costs for chopping and preparing produce, and inadequate local food supply in many places. Given the complex environments in which they operate, school food programs including farm-to-school are best understood with a systems lens, reflecting their rootedness in relationships; policy; politics; infrastructure; and feedback loops of supply, demand, and price.
The number of farm-to-school programs has risen steeply, increasing by 430 percent between 2006 and 2012. Nearly half of US public school districts now have such programs. Between 2012 and 2014, twenty-eight state and local farm-to-school policies were enacted across eighteen states, in addition to federal policy support. A 2015 W. K. Kellogg
Foundation poll found that 88 percent of Americans want to increase public funding for farm-to-school programming. This exponential growth, recognition, and excitement could not have come about without advocacy from both the health and agriculture sectors.
Farm-to-school programming can play an important role in advancing healthier school meal policies. The Department of Agriculture’s (USDA’s) financial support for farm-to-school programming, the Farm to School Grant program, is part of the Child Nutrition Act. This act, reauthorized every five years, has been controversial in part as a result of a 2010 expansion of healthy food requirements. Eighty-six percent of Americans appreciate the changes and believe that nutritional quality has improved. Evidence remains mixed, however, regarding the extent to which students are eating or discarding the mandated fruit and vegetables. Opponents have focused on waste. But many experts attribute high waste levels to inadequate educational and motivational strategies. While the 2015 Child Nutrition Act outcome remains to be seen, farm-to-school programs, including nutrition and agriculture/garden education, represent one valuable public health solution.
2015 Dietary Guidelines For Americans
The case of sustainability in the 2015 Dietary Guidelines for Americans illustrates how reframing a policy issue can result in new public understanding and engagement. The guidelines, reconsidered every five years, form the bedrock of federal nutrition policy. They are the basis of federally supported nutrition education efforts, such as MyPlate.gov, as well as setting the parameters for military rations; the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); and school lunch, among other nutrition programs.
As far back as 1986, experts were advocating that national dietary advice take into account the environmental impacts of food. Several other nations have since incorporated sustainability into their own dietary guidance. While these recommendations address diverse dietary concerns, a constant dietary recommendation is to reduce meat consumption based on the well-documented, disproportionate health and environmental impacts, particularly from red and processed meats. One study, for example, finds that US animal agriculture uses approximately 40 percent of US land area, 27 percent of irrigation, and half of the nitrogen, and furthermore that the sector is responsible for about 5 percent of US greenhouse gas emissions. 30 Low-meat and vegetarian diets are associated with reduced coronary heart disease and type 2 diabetes rates, while diets high in fruit and vegetables are associated with these improvements and reductions in some cancers, among other benefits.
In 2013 the National Research Council and the IOM came together to discuss food production’s environmental implications. They later issued a draft report, “A Framework for Assessing the Health, Environmental, and Social Effects of the Food System.” 3 This report set the stage for significantly realigning the government-issued Dietary Guidelines.
In 2015 the scientific advisory committee for the Dietary Guidelines included environmental sustainability as a decision factor for dietary guidance. The committee report systematically reviewed the literature, concluding: “Consistent evidence indicates that, in general, a dietary pattern that is higher in plant-based foods, such as vegetables, fruits, whole grains, legumes, nuts, and seeds, and lower in animal-based foods is more health promoting and is associated with lesser environmental impact (greenhouse gas emissions and energy, land, and water use) than is the current average U.S. diet.”
Although well supported by evidence, the novelty of this sustainability recommendation and its long-term implications created public fervor. Some industry leaders, driven by concern that changes in dietary advice could affect consumer sales and profits, protested. They argued that including sustainability represented “mission creep” and that the scientific advisory committee lacked sufficient expertise to delve into environmental assessments. Congress weighed in, forbidding the USDA and Department of Health and Human Services from including sustainability in the final Dietary Guidelines. But many health and sustainability experts disagreed and applauded the broadened scope.
The 2010 Dietary Guidelines had garnered a mere 1,159 public comments. In 2015, 29,939 comments were submitted, and more than 150,000 people signed petitions related to including sustainability (Miriam Nelson, Friedman School of
Nutrition Science and Policy, personal communication, July 27, 2015), reflecting unprecedented interest. Regardless of the eventual 2015 Dietary Guidelines, what is clear is that the connection between food system policy and the nation’s health has been made. Looking forward to the 2020 Dietary Guidelines, the next steps may depend on the makeup of
Congress. However, even if Congress again forbids including sustainability, the infusion of new public health voices and public demand around sustainability has contributed to public education and may very well shift the next conversation five years from now.
Conclusion
Food and agriculture are driving forces shaping the public’s health. Addressing them jointly has the potential to open critical policy opportunities for improving nutritional and environmental health. We have described three examples, arising from well over a decade of intersectoral activities: providing children with fresh, healthy meals and building their interest in eating fruit and vegetables while benefiting local farmers; advancing government-sponsored dietary recommendations that recognize the need to nourish not only today’s populations but future ones, too, while preserving environmental health; and reducing overall reliance on antibiotics in livestock production, a critical threat to future antibiotic effectiveness. These cases exemplify the benefits of joint public health and agricultural policies.
They also demonstrate the need to continue bringing together public health and agriculture voices to advocate for policy change. Despite the progress that has been made, these efforts remain the alternative, not the mainstream. For example, even as farm-to-school programming continues to grow, at least half of the country’s school districts still source food only from long-distance supply chains. 22 Furthermore, despite the considerable support for including sustainability messaging in the Dietary Guidelines for Americans, and despite the consumer demand that is leading many food companies to change their antibiotics policies, many with power and authority still do not see the importance and public benefit of making these changes.
The three policy examples discussed here suggest that when health and agricultural concerns are considered simultaneously, with active stakeholder engagement across both sectors, the results can be transformative. Bridge building between sectors certainly does currently occur to an extent in the United States, whether in venues arranged by nongovernmental organizations, academic centers, the White House, or the hundreds of local and state food policy councils. But building bridges across disciplines requires significant time, effort, new learning, and, sometimes, discomfort. There is often a need to partner with “multilingual” allies who can translate across sectors to help strengthen the knowledge, savvy, and effectiveness with which public health scientists, advocates, and practitioners approach new content areas.
In our experience, the public health and agriculture sectors still largely operate in parallel, with separate languages, scientific literatures, meetings, policies, advocacy organizations, and leadership. Too few spaces exist to build critical relationships across both sectors around policy priorities and to exchange perspectives and policy insights. Too little funding, from either private or government sources, is directed at encouraging interdisciplinary collaboration, either to support research linking agriculture and public health or for policy coordination.
But promoting the public’s health demands that these efforts be made. There is a great need for further investment and engagement in the policy, practice, and research activities needed to advance a food systems and public health approach. The policy opportunities described here—just three among many other examples—demonstrate the great promise for jointly improving health, food, agriculture, environment, and the economy.
ACKNOWLEDGMENTS
Roni Neff’s time was funded by the Johns Hopkins Center for a Livable Future with a gift from the GRACE Communications Foundation, which had no role in study design, data collection and analysis, decision to publish, or preparation of the article. The authors thank the anonymous reviewers, editors, and Robert Martin and Marie Spiker of the Johns Hopkins Center for a Livable Future for insightful feedback. They thank Michael Milli, Brent Kim, and Juliana Vigorito of the Center for a Livable Future for assistance.
Roni A. Neff, Kathleen Merrigan, and David Wallinga
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