Improving access to healthy food

Before making investments in school-based supports for child health and well-being, city and county leaders should ensure this strategy addresses local needs.

Mathematica has developed indicator frameworks to help local leaders assess conditions related to upward mobility, identify barriers, and guide investments to address these challenges. This indicator framework can serve as a starting point for self-assessment, not as a comprehensive evaluation, and should be complemented by other forms of local knowledge.

Mathematica's Education-to-Workforce (E-W) Indicator Framework helps local leaders identify the data that matter most in helping students and young adults succeed. Local leaders can use the E-W framework to better understand education and workforce conditions in their communities and to identify strategies that can improve outcomes in these areas.

One indicator in the E-W Framework may be improved with investments in this strategy. To measure this indicator and determine if investments in this strategy could help, examine the following:

• Food security: Percentage of individuals with high or marginal food security, as measured by the U.S. Department of Agriculture’s (USDA) Food Security Survey Module or percentage of individuals living in a census track with low access to healthy food, as defined by the USDA’s Food Access Research Atlas.

• Increasing uptake of nutrition benefits: Increasing households’ purchasing power is among the most important ways to improve access to healthy foods. Federal nutrition assistance programs, namely SNAP, WIC, and the National School Lunch Program, can provide meaningful financial support to lower income households. However, in many communities, a substantial number of households that are eligible for these programs do not access them. Local governments and their partners can fund community outreach and application assistance efforts to increase the uptake of these programs in their communities. Experts note that place-based outreach efforts, like enrollment drives at schools, barbershops, and places of worship, can be particularly effective. Integrating benefits intake processes across social service agencies is another promising approach to drive increased uptake. This approach focuses on creating a “one-stop-shop” for residents, offering a more seamless way for households to check eligibility and sign up for benefits. (For an example of this approach in action, see the Montgomery County Food Council’s food resource specialist program.)

• Matching dollars for households receiving nutrition benefits: Another established strategy that can reduce financial barriers to healthy foods are nutrition incentive programs, like Double Up Food Bucks. Double Up Food Bucks programs currently operate in 25 states, and further strengthen the buying power of SNAP recipients by providing dollar-for-dollar matches on fruit and vegetable purchases. Examples of well-established Double Up Food Bucks programs include Ohio’s Produce Perks and Michigan’s Double Up Food Bucks.

• Create structures to engage food system partners – especially smaller ones: In most communities, the food system is highly distributed. While large actors, like a food bank or grocery store chain, are important, smaller actors, like corner stores or neighborhood community gardens, also represent key access points to food for residents. To reach this broad set of actors, including smaller organizations that may have less capacity, local governments should establish structures to proactively engage these partners. Food policy councils, which aim to be collaborative, stakeholder-driven bodies, are one increasingly common structure to support this type of engagement. Examples of established and successful food policy councils include the Knoxville-Knox County Food Policy Council and the Milwaukee Food Council. Another emerging model, focused on resident engagement, is Baltimore’s (MD) Resident Food Equity Advisor program, which assembles cohorts of residents who intensely engage with city staff on the development of policy recommendations.

• Emphasize cultural relevance in programming: Interventions focused on increasing access to healthy foods will generally be more effective when they meaningfully incorporate the cultural and dietary preferences of the communities they serve. Experts advise that cultural relevance is important to both increasing uptake of and ongoing participation in nutrition education, nutrition assistance, and Food as Medicine programs. Land-grant universities, which administer Expanded Food and Nutrition Education Programs, can be a resource for local leaders on cultural relevance in nutrition programming.

• Residents: Engaging residents – and any subpopulations a program is focused on, in particular – is a key step in understanding local barriers to healthy food access and consumption.

• Grocers and other food retailers: Households typically get the majority of their food from grocery stores and other food retailers, making these organizations key partners in expanding access to healthy foods.

• Food-related CBOs: Communities may have a range of CBOs focused on the local food system, from non-profits focused on community supported agriculture to farmers markets and food pantries. These organizations are often embedded in neighborhoods or within broader communities and can serve as trusted partners when engaging residents.

• Public health officials: City and county public health departments may have expertise on public engagement and education efforts. These agencies are often a source of funding for nutrition education and Food as Medicine programs, as well.

• Public and non-profit social services agencies: Social service agencies are a key intake point for food insecure households seeking assistance. These agencies can be partners in boosting enrollment in nutrition assistance programs, as well as in referring clients to broader food access programming.

• Healthcare providers and insurers: Healthcare systems and providers are key partners in launching and operating Food as Medicine programming. Federally Qualified Health Centers and other clinics that disproportionately serve low-income populations may also be common referral points for those seeking nutrition assistance. Additionally, Medicaid Managed Care Organizations (MCOs) or ACOs, may be key stakeholders when expanding Food as Medicine programming.

• School districts: School districts are often one of the largest food service providers in a community, providing breakfast, lunch, and snacks to students. Schools may also provide nutrition education to students and families.

• Colleges and universities: Researchers may serve as experts when designing nutrition interventions or support evaluation work on a community’s programming. Many Land Grant universities also host program offices focused on nutrition education, urban agriculture, and related topics.

• Lower administrative and programmatic barriers to participation: Long applications, stringent eligibility criteria, and strict program requirements can be barriers to participation in nutrition programming – especially for households with limited time or resources to navigate those processes. In some cases, local actors are limited in their ability to lower these barriers, such as with state administered application processes. (To learn more about the strengths and weaknesses of your state or territory’s nutrition safety net application processes, see Code for America’s Benefits Enrollment Field Guide.) However, when feasible, experts advise local leaders to make use of simple applications and eligibility criteria for programs. More broadly, local leaders may also prioritize integration of intake processes across social service agencies; this step can create a more seamless, “one-stop-shop” for households eligible for multiple programs or benefits. To learn more about best practices for making social services programs more accessible, see Code for America’s Blueprint for a Human-Centered Safety Net.

• Design for a positive client experience: Experts generally advise that local actors design food access programs to create a dignified client experience. For example, many food pantries have switched to a “client choice model,” in which clients are given the autonomy to select their own items, as opposed to receiving pre-determined foods and home goods. By designing for a more positive client experience, local leaders can increase client uptake and retention.

• Create opportunities for participant feedback: Food access programs are often most effective when they can regularly adjust to participants’ needs. Experts advise that programs should create structures to enable participants to provide honest, high-quality feedback on their experience. Common approaches include regular client surveys, community or “alumni” advisor councils, and outreach via paid community ambassadors. For program models that involve third-party intermediaries (e.g., nutrition incentive programs where benefits are redeemed at food retailers), similar feedback mechanisms with those intermediary partners may be useful to identify and solve “back-end” issues.

• Food insecurity: The USDA defines food insecurity as when households are uncertain of having or unable to acquire enough food to meet their needs. This metric can speak to the scale of food insecurity in a community and help local leaders identify any areas where food insecurity is concentrated. These data can be accessed on the U.S. Census Bureau website.

• Nutrition security: Defined by the USDA as consistent and equitable access to healthy, safe, and affordable foods that promote optimal health and well-being. See this tool from Tufts University on screening for nutrition security.

• Incidence of chronic disease: Access to healthy foods can prevent and improve the lives of those with chronic diseases, like diabetes and hypertension. Public health data on chronic diseases can demonstrate the need for programming to expand access to healthy foods, help local leaders identify where in a community the greatest need for resources exists, and potentially serve as an outcomes measure.

• Mental and emotional health outcomes: Food insecurity is directly tied to higher rates of stress, anxiety and depression. Access to nutritious food can lower these rates, which contribute to overall positive health outcomes.

• Cost of chronic disease: Quantifying the cost of managing chronic illnesses can help make the case for investments in preventative measures, like increasing access to healthy foods, as well as Food as Medicine programs, which can improve outcomes for individuals with these conditions on a cost-effective basis.

• Participation rates in nutrition assistance programs: In many communities, more residents are eligible for nutrition assistance programs, like SNAP and WIC, than actually receive benefits. Determining the proportion of eligible households that are actively enrolled in these programs can help local leaders determine if residents need greater assistance in accessing these resources.

• Food access points: Identifying and mapping food access points, like grocery stores, farmers markets, and corner stores, can help local leaders understand geographic barriers to healthy food access in their community and target interventions accordingly.

• Programmatic data: Programs focused on increasing access to healthy foods may be able to use programmatic data to demonstrate their impact. The appropriate metric will vary depending on program type. For example, tracking participants’ blood pressure may be appropriate for a produce prescription program, while a nutrition education program may be more interested in rates of fruit and vegetable consumption.