Policy Update – The Friedman Sprout

WIC at the Crossroads of the Opioid Epidemic

March 1, 2017 by friedmansprout Leave a Comment

by Danièle Todorov

The complexity and pervasiveness of the opioid epidemic has forced government agencies to be innovative with their resources. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in a prime position to care for pregnant women affected by the epidemic and has stepped up to the plate.

In January of 2016, then Secretary of Agriculture Tom Vilsack was appointed by President Obama to lead an interagency taskforce to address the opioid epidemic in rural America. Secretary Vilsack, who’s been outspoken about his own mother’s struggle with prescription drug addiction, knew that compassion and collaboration would be vital. His agency, the USDA, has unique resources and relationships in rural areas, putting it in a prime position to address the epidemic.

Addressing the epidemic is no simple task. According to the CDC, 91 Americans died daily from opioid overdose in 2015. Nearly half of these deaths involved a prescription opioid, used in the treatment of pain. In a town hall meeting in Missouri last July, Secretary Vilsack stated that due to “the devastating toll that opioid misuse has taken on our communities, and particularly rural areas, I have tasked USDA with creatively using all of the resources at our disposal to stem the tide of this epidemic” [1]. Interestingly, Secretary Vilsack highlighted WIC as a resource that could be creatively used. “For many women”, he stated, “WIC is their first point of entry into the healthcare system, and we have an opportunity to intercept and potentially prevent dangerous health outcomes for both the mother and the child” [1].

Pain management is an important part of pregnancy care. The prescription of opioids for pain in pregnancy is increasingly common; 1 in 5 Medicaid-enrolled women were prescribed an opioid at some point during their pregnancy in 2014 [2]. However, the effect of opioids on birth outcomes is understudied. In utero opioid exposure may be associated with preterm delivery and low birth weight [3]. Exposed neonates may develop withdrawal symptoms, a condition known as neonatal abstinence syndrome, which is associated with increased risk of seizures and breathing difficulties [3]. Similarly understudied are the rates of opioid abuse during pregnancy. We do know that pregnant women with substance abuse problems are particularly vulnerable to food and job insecurities and unstable housing, which exacerbate potential health complications [4].

The healthcare system often stigmatizes and underserves pregnant women with substance abuse problems. However, WIC is increasing its ability to engage them in care. WIC’s mission is to promote the health of low-income women and their children by providing nutritious food, health education, and referrals. Starting in 2014, WIC agencies have increased staff training surrounding substance abuse [1]. Staff are better equipped to notice potential substance abuse, to educate WIC participants about the dangers of substance abuse during pregnancy and breastfeeding, and to connect them with local resources. These expanded roles align with WIC’s mission, not only because they aim to protect the health of the women they serve, but because WIC “acknowledges that substance use is incompatible with good nutrition” [5].

WIC is forming relationships with women at a promising point in time in their lives. In their staff training guide, WIC cites a study showing that women are “more motivated to improve their lifestyle and health habits during periods when they make the transition from one life situation or role to another… WIC participants are a natural target audience for substance use information because they are, by definition, in the life transition stage of pregnancy and new motherhood” [5].

WIC is playing an important part in the collaborative response to the epidemic. As the director of the USDA, Secretary Vilsack understood that a holistic response was the only effective solution and embraced President Obama’s mandate. “This disease isn’t a personal choice,” says Secretary Vilsack, “and it can’t be cured by willpower alone. It requires responses from whole communities, access to medical treatment, and an incredible amount of support. To me, our mandate is clear: don’t judge, just help” [6]. Secretary Vilsack’s endorsement of his replacement as Secretary of Agriculture, nominee Sonny Perdue, gives hope that the USDA will continue this vital endeavor.

Sources

Agriculture Secretary Vilsack Announces Substance Misuse Prevention Resources for Low Income Pregnant Women and Mothers In Order to Battle the Opioid Epidemic, U. Office of Communications, Editor. 2016.
Desai, R.J., et al., Increase in prescription opioid use during pregnancy among Medicaid-enrolled women. Obstetrics and gynecology, 2014. 123(5): p. 997.
Patrick, S.W., et al., Prescription opioid epidemic and infant outcomes. Pediatrics, 2015. 135(5): p. 842-850.
Sutter, M.B., S. Gopman, and L. Leeman, Patient-centered Care to Address Barriers for Pregnant Women with Opioid Dependence. Obstetrics and Gynecology Clinics of North America, 2017. 44(1): p. 95-107.
Substance Use Prevention: Screening, Education, and Referral Resource Guide for Local WIC Agencies, F.a.N.S. U.S. Department of Agriculture, Editor. 2013.
USDA. Addressing the Heroin and Prescription Opioid Epidemic. 2016 02/17/17].

Danièle Todorov is a first-year nutritional epidemiology student with a focus on pregnancy nutrition and birth outcomes.

Filed Under: News, Nutrition Research, Policy, Policy Update, Science Tagged With: opioid epidemic, President Obama, Secretary of Agriculture, Tom Vilsack, USDA, WIC

Coca-Colonization in Mexico: The Soda Tax that Almost Wasn’t

December 1, 2015 by friedmansprout Leave a Comment

by Ally Gallop, RD, CDE

A year ago, I praised the Mexican government’s seminal 10% soda and 8% junk food taxes, which took effect January 1, 2014. The result? Soda consumption dropped by 6% and bottled water consumption increased by 4%. Yet nearly two years later, relentless soda lobbyists tried to cut the tax in half. Did you hear about that?

As someone who lacked a policy background prior to attending Friedman, I relied on the media to inform me about important nutrition policy issues; I didn’t seek these out. Of course, once at Friedman my interest level soared, and I began following nutrition policy. However, I realized that what initially makes the cut for national media attention isn’t always followed up.

Thanks to a prompt from Marion Nestle’s “Food Politics” blog, I found the follow-up I valued: Does anyone ever wonder what happened to the Mexican soda and junk food taxes passed in 2013? Let’s run through Mexico’s story together from the very beginning.

A 6-step guide through soda taxes in Mexico:

#1. 2006: The alarm sounded in Mexico

The release of the Mexican National Survey of Health and Nutrition instilled panic in the government: Between 1999 and 2006, the average waist size of adult women increased by 4.3 inches, childhood obesity increased by 40% in those aged 5-11 years, soda intake nearly doubled in adolescents and tripled in adult women, and the prevalence of diabetes had doubled (diabetes is the country’s leading cause of mortality). Furthermore, the top three sources of calories in the Mexican diet all came from high-calorie drinks.

Alarmed, the financial arm of the Mexican government consulted the Center for Research in Nutrition and Health at Mexico’s National Institute of Public Health. The Center’s solution was to cut sugar-sweetened beverage (SSB) consumption via an excise tax.

#2. 2012: The assistance of Michael Bloomberg

After Michael Bloomberg’s rejected soda tax in New York City, he continued to look for similar opportunities elsewhere. Industry money for lobbying was a major reason for his setback in New York, so in 2012 his foundation, Bloomberg Philanthropies, invested $16.5 million over a three-year period to match the Mexican soda industry’s anti-tax efforts. This investment allowed Mexico to fight on an even playing field against industry.

#3. October 2013: Mexico introduced a soda and junk food tax

The implementation of the Mexican taxes resulted from a unique set of circumstances. The government was looking for a swift way to prevent the continuous rise in diabetes and obesity. They were also looking for a means to raise money federally—the tax was hoped to raise $1.5 million per year. President Peña Nieto was in favor, but many in his party, the PRI, were not. The intra-governmental disagreement stemmed from close ties to soda: the PRI had previously accepted industry money, diabetes centers were funded by soda, and the industry had infiltrated both the country’s health secretary and the National Council on Science and Technology. All spoke out against the tax in favor of educating the public and promoting physical activity.

In a rare move of assessing public support, the government polled its citizens: 70% were in favor of the tax if revenue was directed to investing in water fountains in public schools.

The tax passed. Taking effect on January 1, 2014, the taxes would result in a one-peso-per-liter (10% or $0.08) tax on SSBs and an 8% tax on junk food supplying more than 275 calories per 100 grams. The tax neglects bottled water, flavored milk, and diet sodas. However, a VAT tax of 15% remained on these items.

#4. May to September 2015: Mexico drank less: Research showed the tax had been effective

Research out of the Mexican National Institute of Public Health, the University of North Carolina, and Euromonitor showed that during 2014:

Sales of SSBs fell by 6% overall
Sales of bottled water increased by 4%
SSB consumption dropped from 163 to 136.6 liters per person per year, declined by 10% in the first three months of 2014 (compared to the same period in 2013), and across all socioeconomic groups
The tax disproportionately affected the poor with SSB reductions of 9%. Yet diabetes also disproportionately affects the poor, who are less likely to have insurance to cover the disease’s medical costs

Further, the tax resulted in $1.2 billion USD in government revenue with $900,000 USD authorized for the installation of water fountains in schools. There were also 1,700 job cuts from industry due to decreased sales.

#5. October 2015: The soda industry fought back

Unsurprisingly, these victories made the soda industry unhappy. News broke in early October that the Mexican government’s lower house passed an amendment to cut the 10% tax in half for SSBs providing less than 5 grams of sugar per 100 milliliter. The reduction was aimed at providing industry incentive to reformulate its products to contain less sugar. The PRI apparently negotiated with FEMSA (the world’s largest bottling company located in Mexico) to reduce the tax.

However, once the public became aware of this, government parties scrambled and denied that they were ever in favor of the amendment.

#6. November 2015: The government’s change of heart

Ultimately, the senate overturned the amendment. The original taxes remain.

Ally Gallop, RD, CDE is a second-year nutrition communication and behavior change student focusing in U.S. food and nutrition policy. She prefers to sip on Americanos.

Filed Under: Policy, Policy Update, Uncategorized Tagged With: berkley soda tax, coca cola in mexico, soda tax effects, soda tax in mexico, SSB Tax, SSBs in Mexico, sugar sweetened beverage consumption

Water Prices Across the United States: How Does Your Bill Stack Up?

April 8, 2014 by friedmansprout 2 Comments

by Lindsey Webb

If you’re like me, you don’t spend very much time thinking about your water bill. You turn the water off when you’re brushing your teeth and limit your shower time, but in the end, you use what you use and you pay for it every month, just like everyone else across the country. In reality, though, things are a bit more complicated; what you pay depends a lot on where you live.

Availability or scarcity of water in your area doesn’t entirely determine what you pay for it. Playing a huge role is the rate structure chosen by the municipality where you live. (State policies can also have some influence.)

Most cities charge a fixed fee to start off with, but beyond that they have a number of different rate structures to choose from. For example, Memphis, New York, and Chicago charge a uniform rate for every unit of water consumed. Fresno, California does as well, though given the recent drought in California, there have been calls to re-evaluate water pricing in a number of California cities.

Denver, Jacksonville, and Boston use an “increasing block”structure where users are charged more for higher amounts used. Users in these areas might pay a lower rate for the first 1000 cubic feet of water consumed, but a higher rate for the next. This structure provides a stronger incentive to conserve water than a uniform price structure, since the price per unit increases the more you use.

A “decreasing block”structure, used by a handful of major cities like Baltimore, Detroit, and Indianapolis, is the opposite. Users in these cities are charged less for higher amounts of water used, providing less of an incentive to conserve.

Cities acknowledging seasonal variation in water availability include Phoenix, Salt Lake City, Los Angeles, and Seattle. The latter three cities use a seasonal increasing block structure, which is similar to the increasing block structure –the difference is that rates are higher in the peak season. Phoenix uses a seasonal uniform block structure where the prices paid during peak season and low season do not depend on the amount used.

So, in which cities do consumers pay the most for their water use? According to a 2013 survey by Circle of Blue, an association of scientists and journalists focused on water issues, average water bills for the 30 major U.S. cities vary quite widely. For a family of four using 50 gallons of water per person per day, the average monthly water bill in Phoenix was the lowest at just $11.55. Other low payers include Memphis ($11.79) and Salt Lake City ($16.55).

On the other end of the spectrum, a family of four using the same amount of water in Santa Fe, New Mexico could expect to pay $54.78 per month. Seattle residents paid the second highest at $51.10, perhaps the opposite of what one would expect given the city’s rainy reputation. San Diego, San Francisco, and Atlanta all had average monthly bills of over $40. Here in Boston, the average monthly bill for a family of four consuming 50 gallons of water per day is somewhere in the middle at $36.08.

For more information and a complete listing of the 30 cities’average water bills, see http://www.circleofblue.org/waternews/2013/world/the-price-of-water-2013-up-nearly-7-percent-in-last-year-in-30-major-u-s-cities-25-percent-rise-since-2010/

Lindsey Webb is a second year FPAN student who is very excited about graduating in May, in part because she can binge-watch all of the Chopped episodes she missed this year. Learn more about her on our Meet Our Writers page.

Filed Under: Features, Policy Update

Are conservation dollars polluting our water?

April 8, 2014 by friedmansprout Leave a Comment

by Alyssa Charney

Many conservation programs in the Farm Bill aim to help producers protect water quality from impairment from agricultural inputs. However, since 2002, funding from the Environmental Quality Incentives Program (EQIP) has been flowing to concentrated animal feeding operations (CAFOs), which are contaminating, rather than protecting, critical water resources. The 2014 Farm Bill failed to reform EQIP’s funding of these operations.

EQIP is a working lands conservation program that was established in the 1996 Farm Bill to allow agricultural and livestock operators to enroll in 5 to 10 year contracts to manage natural resource concerns. EQIP provides financial and technical assistance to producers to address natural resource concerns and deliver environmental benefits. Common practices include planting cover crops to prevent erosion or installing fencings for grazing rotations.

Despite EQIP’s conservation objectives, nearly 40 percent of the program’s funds currently go to CAFOs for waste storage facilities and irrigation equipment installation. And yet even with EQIP funding, CAFOs do not effectively manage the large amount of waste they produce.

Animal manure and urine from CAFOs are funneled into and stored in massive waste lagoons, which often overflow, leak, or break and send dangerous contaminants into water supplies. These lagoons are frequently located within floodplains on aquifers, directly contaminating the drinking water supply. Additionally, liquid manure stored in the lagoons is sprayed onto cropland or pastures through large sprinkler irrigation systems that over apply waste to levels that exceed what is needed to maintain soil fertility. Liquid waste from the sprayfields runs off into streams, lakes, rivers, and estuaries.

Manure lagoon (Source: USDA).

The lagoons and irrigation pivots used by CAFOs are sucking up EQIP funding in the name of environmental conservation.

However, this wasn’t always the case. Between 1996 and 2002 CAFOs were ineligible to receive EQIP funding. But in response to a massive lobbying campaign from corporate meat industry interests, the 2002 Farm Bill increased the EQIP payment limit from $50,000 to $300,000 and CAFOs were deemed eligible. Funding priorities also shifted to favor projects with the greatest pollution potential instead of the most cost-efficient applications, again favoring CAFOs over small and midsized farms that wish to integrate pollution preventing practices on their operations.

Even with the EQIP funding CAFOs receive, CAFOs do not effectively manage the massive amounts of waste they produce.

Reforming EQIP to prevent CAFOs from receiving funds would have provided more needed support to farmers who are safeguarding, rather than further damaging, natural resources. Unfortunately, the 2014 Farm Bill not only failed to decrease the payment limit for EQIP, but it actually increased that limit from $300,000 to $450,000 per contract. CAFOs remain eligible and polluting livestock operations can continue to receive a disproportionate share of EQIP funding.

Public health and sustainable agriculture advocates have called for a variety of reforms to address the disproportionate share of EQIP funding that CAFOs receive.

The National Sustainable Agriculture Coalition (NSAC)’s platform proposed that the Farm Bill should reduce the program-wide payment limit for EQIP from $300,000 to $200,00 per contract, as the average contract today is still smaller than the program’s original payment limit of $50,000, and CAFO applications receive larger contracts. NSAC added that if Congress does continue to fund CAFOs through EQIP, it should at least eliminate payments made to any new or expanding operations and to those located within flood plains.

Similarly, the Union of Concerned Scientists has called for the elimination of the waste-management subsidies that CAFOs receive under EQIP in order to provide more needed support to small and mid-sized farms. The Environmental Working Group (EWG) has also identified the effects of CAFOs on human health and the environment as reason to reform EQIP to prohibit CAFOs from receiving funding.

And the American Public Health Association (APHA) has pointed to the dangers that CAFOs present to contaminated drinking water and called for a moratorium on new operations. APHA cited a number of water-related health concerns including the contamination of drinking water with pathogens from manure.

What’s next?

While the Farm Bill fails to provide much needed reform to CAFOs’ EQIP eligibility at the federal level, state technical committees can play a significant role in determining which EQIP applications are or are not funded. The technical committees can, and should, advise state conservationists to restructure the way NRCS ranks applications, in such a way as to favor sustainable practices rather than those specific to CAFO waste management. Funding manure lagoons or pivot irrigation equipment for CAFOs should be especially discouraged.

States should not sit around and wait another five (or more) years for Farm Bill reform to stop wasting conservation dollars on water polluting CAFOs. The time for a shift in EQIP funding priorities is now.

Alyssa Charney is a first year AFE/MPH student. Also in the WSSS program, she’s excited about the water that helps grow the food we eat and the water that hydrates her as she gets ready to run the Boston Marathon. She grew up on the east coast, but loves Montana’s mountains that were home before arriving at Friedman. Alyssa can be reached at alyssa.charney@tufts.edu.

Filed Under: Features, Policy Update

Holy Cow! Milk Gets A New Ad Campaign

March 6, 2014 by friedmansprout 1 Comment

by Mimi DelGizzi

David Bekham had one, as did Taylor Swift and Beyonce. Even Superman had one. The Olsen Twins sported two. Since 1994, celebrities have donned milk mustaches for the “Got Milk?” campaign, but after two decades, the Milk Processor Education Program (MilkPEP) is retiring the slogan in favor of a new message. The new tagline for the calcium-rich drink is “Milk Life” and features everyday folks performing (almost) everyday tasks, but with more gusto.

Launched Feb 24^th, the new campaign moves away from the celebrity-studded image “Got Milk?” had generated (over 300 different celebrity ads were created for the campaign). According to ad executives, the use of celebrities was meant to bring excitement to an otherwise “boring product.” In fact, according to a report put out by the USDA, Americans born in the 1990s are less likely to drink fluid milk with lunch or dinner compared to Americans born in decades prior. Unfortunately, oftentimes sodas and other sugar drinks take the place of milk on modern dinner tables.

courtesy of NPR.org

Instead of trying to revitalize a low-interest item, then, the new “Milk Life” campaign aims to slingshot milk into a spot it has not been since its “Does Your Body Good” days: touting milk’s nutritional benefits, particularly the protein content in one glass of the stuff—about 8 grams. The new ads depict liquid milk powering consumers through a myriad of physical activities. One ad shows a child jumping off a diving board, wings of milk giving her the chutzpah to do so. Another ad depicts a young man breakdancing and swirling liquid milk in circles around his body. The ad reads, “What 8 grams of protein looks like when you’re breaking the laws of physics.”

In an article on NPR’s food blog, The Salt, the marketing director of MilkPEP, Victor Saborsy, explains that “you can read ‘Milk Life’ two ways”: urging consumers to milk life, enjoying it to the fullest, or encouraging them towards “living a milk life” by making milk a central part of a healthy diet.

At a time when dairy milk sales are contending with increasingly popular non-dairy alternatives like soy and almond milk, the new “Milk Life” campaign wants to make sure consumers still know that yes, milk (still) does the body good.

Drink on.

Michelina (Mimi) DelGizzi is a 2nd-year dual degree MS/MPH student and the current Co-Editor of The Friedman Sprout. To learn more about her, visit our Meet Our Writers page.

Filed Under: Features, Policy Update