Friedman Policy Corner: Massachusetts Bill Seeks to Ban School Lunch-Shaming

by Alana Davidson

The Massachusetts Law Reform Institute released a report this Spring on lunch shaming in Massachusetts schools. Lunch shaming is when children are denied a meal or given an alternative cold cheese sandwich because they cannot afford the food. Read more about this issue and what legislation has been put forward to address it!

“Denying children food and humiliating them because they are poor are not the values by which most residents of Massachusetts live. We can stop lunch shaming in Massachusetts and by doing so, continue to be the nation’s leader when it comes to education and child welfare.” – Patricia Baker, MLRI Senior Policy Analyst

In public schools across Massachusetts, children line up every day for lunch and fill their trays with healthy, nutritious food. Some children, however, may get to the front of the cafeteria line only to have their lunch tossed into the garbage in front of their friends, or have their hot meal swapped for a cold cheese sandwich because they don’t have enough money for food or have previously accumulated meal debt. A recent report from the Massachusetts Law Reform Institute (MLRI) examined meal debt policies across the state and found disturbing results. Schools prohibited students, and their siblings, with meal debt from participating in field trips, graduation and after school activities, and withheld report cards and grades. Even worse, schools referred families with school meal debt to the Department of Children and Families (DCF) or referred them to outside loan collection agencies that tend to have high interest rates and fees. These unacceptable “lunch-shaming” policies stigmatize low-income students and their families and leave children hungry and ashamed.

Why does “lunch-shaming” exist in U.S. schools? The National School Lunch Program (NSLP) provides free or reduced-price meals to children who participate in certain federal assistance programs, are homeless or in foster care, or have an income at or below 185% of the federal poverty line. However, some families that qualify for the program may not be enrolled and even those with an income too high to qualify may still struggle to afford food. Feeding America’s Map the Meal Gap found that 33% of food insecure people in Massachusetts have an income too high to qualify for federal assistance programs. The School Nutrition Association found in their nationwide 2016 survey that 76% of school districts had unpaid student meal debt and 38% of schools reported an increase in the number of free and reduced-price meal students who could not afford lunch.

In 2016 the USDA released rules that “no later than July 1, 2017, all SFAs [schools] operating NSLP and/or SBP [school breakfast] must have a written and clearly communicated meal charge policy in order to ensure a consistent and transparent approach to this issue.” However, MLRI’s recent report found that among schools examined 30% of elementary schools and 28% of secondary schools had no publically posted meal charge policies. Still more it was hard to find the policies that did exist, which were in student handbooks or school committee rules. Student handbooks can be hundreds of pages long. Schools need to post their meal charge policies in a place that is easy for families to find and access.

I filed this legislation because no child should be shamed for being hungry. Every child deserves access to a healthy, nutritious school lunch and this legislation will ensure that students in Massachusetts can access the meals they need to grow and learn.” – Senator Cynthia Stone Creem (D. Newton)

It is time for Massachusetts to join New Mexico, California, Oregon and Washington State in banning these shameful practices and ensure that every child in the state is provided a healthy, nutritious school meal regardless of ability to pay. Senator Creem and Representative Vargas hope to do just that with their new bill (S.2390/H.4422). This bill bans all of the following with regards to a child’s inability to pay for a meal or a previously incurred meal debt: throwing out a meal, publicly identifying a student, excluding a student and the student’s siblings from extracurricular activities and school events, withholding reports cards or grades, denying or delaying a reimbursable meal to a student, and charging families fees and costs beyond what is owed for the meal. It also requires that all communication about meal debt is conducted with the parents rather than the child, which is currently not the case.  It should not be the child’s responsibility to deal with this issue, and the DCF should not be notified due to meal debt alone. In addition, the bill works to maximize federal reimbursements and minimize meal debt by outlining how often schools must check and enroll students who directly qualify for NSLP (TANF, SNAP, Medicaid recipients; foster child, homeless, migrant). For the students with meal debt who do not directly qualify for NSLP, schools are required to send parents information regarding SNAP and a NSLP application.

Finally, the bill includes language that schools and/or districts with 40% or more economically disadvantaged students must elect into the community eligibility provision (CEP), with exemptions. This provision came out of the Obama Administration and allows schools where 40% or more of students directly qualify for NSLP to serve free breakfast and lunch to all students. To learn more about CEP, check out the Food Research & Action Center’s guide. Currently, there are many schools in Massachusetts that qualify for CEP but have not enrolled, including Amesbury Public Schools, Conservatory Lab Charter Schools, Fall River Public Schools and Lynn Public Schools. CEP can lead to higher federal reimbursements for schools, increase participation in NSLP, and reduce administrative costs.

The bill has received a committee extension order, meaning it has more time to be acted on by the committee before this session ends (e.g. reported out of committee favorably). There will be a hearing on the bill in May. Call your state legislators and tell them to ban school lunch shaming and to support this bill! You can find contact information for your state legislator here. No child should be denied a healthy, nutritious meal or stigmatized because he or she cannot afford it. Let’s ensure all children in Massachusetts have access to healthy, nutritious food in school so they can succeed today and into the future.

Alana Davidson is a first year MS candidate in the Food Policy and Applied Nutrition program and one of the founding members of FFPAC. For the last three years she has interned in the anti-hunger field at the Food Research and Action Center (FRAC), Share Our Strength, and End Hunger Connecticut!. Her research and advocacy have centered on domestic food insecurity and nutrition-related issues. Davidson also contributed to MLRI’s anti-lunch shaming report.

The Friedman Food Policy Action Council (FFPAC) is a student-run organization of the Friedman School of Nutrition Science and Policy at Tufts University. Our mission is to advance evidence-based nutrition and agricultural policies in support of public and environmental health, by equipping students with the skills and relationships necessary to impact policy through advocacy. For more information, or to join FFPAC, please contact friedmanfpac@gmail.com.

 

Trump’s Trade Wars: How Steel and Aluminum Might Harm Hog Farmers

by Sam Jones

President Trump has been waging a trade war since early March, with China as his greatest adversary. Steel and aluminum manufacturing stood to benefit from these protectionist measures, but the U.S. agricultural sector is actually getting the raw end of the deal in this tit-for-tat dispute.

In the beginning of March, President Trump announced plans to place a 25% import tariff on all steel and a 10% import tariff on all aluminum. To follow through on his campaign promise of U.S. trade protectionism, the U.S. steel and aluminum manufacturing industry is the first group of intended beneficiaries. President Trump claims that unfair trade practices in other countries, namely China, have flooded the global market with these products, effectively lowering prices to uncompetitive levels.

The steel and aluminum manufacturing industry in the U.S. has seen a significant decline in jobs, with 135,000 people employed in the industry in 2000 compared to just over 83,000 in 2016, according to one source. However, industries that purchase steel and aluminum and rely on the current low prices actually employ far more people—6.5 million—than are employed on the manufacturing side. These industries include car manufacturers, beer companies, and the construction industry, to name a few. As a result, while these tariffs may be good news for a few tens of thousands of steel and aluminum manufacturers, over six million people employed by steel and aluminum buyers would likely be negatively impacted and possibly lose their jobs if production costs rise.

However, this only would have been the outcome if President Trump’s original plan to tax all steel and aluminum imports entering U.S. borders had become reality. The tariffs did go into effect at the beginning of April, but Canada and Mexico were immediately exempted from these trade restrictions. Before the tariffs had officially taken effect, the EU, Australia, Argentina, Brazil, and South Korea were granted temporary exemptions from the tariffs as well.

These trade exemptions are essentially being granted to political allies of the United States who threatened strict and politically targeted tariffs of their own in retaliation. These tariffs would have been imposed on quintessential American products, like Wisconsin cheese and Kentucky bourbon, that are produced in red majority regions (Wisconsin is Paul Ryan’s home state).

Politically, exempting these countries is a good idea because of this potential backlash, but these exemptions also severely undermine the original intention of the steel and aluminum tariffs. Canada, the EU, South Korea, Mexico, and Brazil are the top five sources of steel and aluminum imports for the U.S., with over $900 million-worth of imports coming from Canada and the EU alone. So which steel and aluminum exporters are affected by this policy? In one word: China.

Just like the retaliatory measures threatened by the exempted countries, China has its own punitive measures in mind. The potential targets of China’s tariffs are major U.S. agricultural export commodities like pork, soybeans, sorghum, tobacco, wine, and nuts. These products are chosen for specific, political reasons. The international community is well-aware of how the structure of our government impacts elections results. They know which districts voted red and which ones swung blue, which means they know that to impact the voters in red districts, they can target the industries that fuel their livelihoods. For instance, China is the largest consumer of both the pork and tobacco that is produced in North Carolina. As it happens, North Carolina went to Trump in the 2016 election. Not only is China retaliating against protectionist trade measures, but it also seemingly intends to aim their retaliation at President Trump and the Republican party directly.

The same can be said for taxing soybeans, most of which come from the Heartland that overwhelming votes Republican each election cycle. As for putting tariffs on wine and nuts, most of the nut exports come from California, which is a tried-and-true blue state. However, the Central Valley of California swings red and is the largest region of tree nut production in the country.

Hogs at Jodar Farms in Fort Collins, CO

Photo credit: Sam Jones

These politically-rooted trade tariffs may also help to explain why President Trump and his staff decided to exempt the countries they did. A reduced export market, or even a reduction in prices due to speculation, for Wisconsin cheese and Kentucky bourbon would not have been good for the political representatives of those districts. Such repercussions, however, seem unavoidable. When pork producers in North Carolina feel the repercussions of fewer sales and lower prices, they will tie their struggle directly back to President Trump’s decision to start a trade war with China.

As history continues to prove, the losers of trade wars almost always outnumber the winners. From the initial tariffs, the companies and their employees that rely on cheap steel and aluminum imports will suffer as production costs rise. Consumers of steel and aluminum products—like your thirst-quenching 12oz. can of PBR or a shiny Ford F-150—will suffer as higher production costs are pushed onto them. From China’s retaliatory measures, the U.S. farmers who produce the taxed goods will also suffer. Likewise, consumers in China will suffer from higher prices of these taxed U.S. agricultural products.

American farmers of competing products will also suffer because excess pork that cannot be exported will flood the domestic market, and consumers might switch from beef or chicken to the now-cheaper pork. With less beef and chicken consumption, corn and soy producers will also feel a hit. And with everyone’s prices falling, non-farm agricultural input industries will feel the trickle-down effect on top of revenue loss from rising steel and aluminum prices.

Because the steel and aluminum tariffs don’t even apply to the five largest exporters, the U.S. steel and aluminum manufacturing industry is not likely to experience a significant economic boost. In the end, Trump’s trade war managed to single out an openly hostile political adversary that was already facing steel and aluminum tariffs due to its unfair dumping practices. As a major importer of U.S. agricultural products, a disgruntled China ends up straining American farmers more than anyone else. And if it ends up hurting them so badly that they decide to release their frustration at the polls, there just might be a blue majority in the house this fall.

Sam Jones is a first-year AFE student with an interest in sustainable agriculture and food journalism. She is currently an intern at Culture Magazine and will be working on a flower farm this summer. You can read more of her work at culturecheesemag.com.

Friedman Policy Corner: A Call to Action for Aspiring Food Activists

by Ayten Salahi (MS/RD-FPAN) and Marielle Hampton (MS-AFE)

On February 5, the Friedman Food Policy Action Council (FFPAC) convened its inaugural meeting. Massachusetts Congressman Jim McGovern stopped by to offer words of wisdom, encouragement, and a call to action.

Congressman Jim McGovern offers words of wisdom at the inaugural meeting of new Tufts advocacy group, Friedman Food Policy Action Council.

Congressman Jim McGovern offers words of wisdom at the inaugural meeting of new Tufts advocacy group, Friedman Food Policy Action Council.

Congressman Jim McGovern surprised Tufts students with an impromptu visit at the first meeting of the newly formed Friedman Food Policy Action Council (FFPAC) on February 5, one week before the Trump administration announced its budget request for fiscal year 2019. Congressman McGovern, champion of anti-hunger causes and ranking member of the House Subcommittee on Nutrition, was visiting the school to discuss his recently launched bipartisan Food is Medicine Working Group in the House Hunger Caucus.

During the meeting, Congressman McGovern expressed his appreciation for the student initiative to get involved in advocacy, since “academia doesn’t always translate into activism.” When FFPAC founding member Ayten Salahi requested words of wisdom for students looking to get involved in political action, McGovern chuckled. “This is the toughest year you could have picked to get started, but that’s why it’s so incredibly important.”

He urged students to remember that people in government are supposed to be working for them. Even in the current political climate, he said, “pressure works.”

So how can students and citizens help? “Every elected official has one thing in common: they want to get re-elected. These issues are important enough that these people need to know if they’re not with you, you’re not with them. There has to be consequences… Nobody would tell you they’re pro-hunger, but judgment should be based on actions.

The Congressman then offered a crucial piece of advice that he adopts in his professional and personal life: Correct misinformation and provide facts.

Even in Congress, falsehoods are repeated regularly. He makes a point to correct the record, whether at a family dinner or among colleagues. “The average SNAP benefit is only about $1.40 per person per meal and the majority of people on SNAP are kids and senior citizens or disabled,” he explained. “The majority of beneficiaries who can work, work. The majority of people on SNAP are white, despite misconceptions. The USDA has been very effective at cracking down on SNAP fraud.”

Congressman McGovern’s guidance to hold our elected officials accountable may prove especially important for food and nutrition advocates this year, with changes to the Farm Bill slotted for congressional review in March.

On Monday, February 12th, the Trump administration announced its budget request for fiscal year 2019, which included a plan to cut 30% – $214 billion – from the SNAP budget over the course of 10 years. The proposed “cost-savings” would result from a major shake-up in the program’s benefit structure. Among the proposed changes, one has received significant publicity: Instead of receiving monthly funds loaded into EBT cards as is currently done, SNAP beneficiaries receiving $90 or more per month would receive half of their benefits in the form of a “USDA Foods Package,” packed with predetermined food items specifically chosen for their long shelf life. The package would include cereals, pastas, canned foods, peanut butter, and shelf-stable milk. Notably, no fresh fruits and vegetables would be included. No one has seen if or how these changes would be reflected in the 2018 Farm Bill.

While the administration calls the proposal a “cost-effective, Blue-Apron-style approach” with “no loss in food benefits to participants,” stakeholders are skeptical that the proposed “Harvest Box” is anything more than a distraction from work underway behind the scenes to slash federal funding for food assistance programs. Stacy Dean, vice president for food assistance policy at the Center on Budget and Policy Priorities says, “I don’t think there’s really any support for their box plan. And, I worry that it’s a distraction from the budget’s proposal to cut SNAP by some 30 percent. That’s the real battle. But all anyone is talking about today are the boxes.” Ranking democrat on the agricultural committee Senator Debbie Stabenow also cautions that this “isn’t a serious proposal and is clearly meant to be a distraction.” Shortly following the release of the budget proposal, administration officials admitted that the food box plan had “virtually no chance of being implemented anytime soon,” rousing further suspicion around the administration’s motives in publicizing it so widely.

During his visit with FFPAC, Congressman McGovern expressed similar concerns, and emphasized how important it is that food policy activists and SNAP beneficiaries alike demand transparency from members of the House Committee on Agriculture on the drafting of the 2018 Farm Bill. Despite his role as Democratic ranking member of the House Subcommittee on Nutrition, Congressman McGovern shared that neither he nor his Republican counterpart has seen a single sentence of the updated Farm Bill, now under review with the Congressional Budget Office (CBO). He cautioned this lack of transparency around the latest draft as “a sign that someone is hiding something.”

Though it remains to be seen, the bill is anticipated to reflect significant reductions in the federal SNAP budget, which will have a direct and jarring impact on the sustenance and economic freedom of nearly 46 million low-income Americans who depend on the program to nourish both themselves and their families.

In his closing remarks, Congressman McGovern issued a call to action for us at Friedman – and for all those invested in the protection of health equity, food security, and social welfare – to call our representatives, and to demand transparency around the content of the latest Farm Bill, and when it will be made available for review. In the coming months, FFPAC pledges to maintain a finger on the pulse of the upcoming Farm Bill and rally advocates to hold representatives accountable for votes that jeopardize SNAP program benefits.

Friedman Food Policy Action Council (FFPAC) is a student-run organization of the Friedman School of Nutrition Science and Policy at Tufts University. Our mission is to advance evidence-based nutrition and agricultural policies in support of public and environmental health, by equipping students with the skills and relationships necessary to impact policy through advocacy. For more information, or to join FFPAC, please contact friedmanfpac@gmail.com

Ayten Salahi is a first-year FPAN MS/RD candidate, co-founder of FFPAC, and is dedicated to the future of policy, programming, and clinical practice in sustainable diets and nutrition equity. Ayten came to Friedman after working as a molecular and clinical researcher in neuropharmacology and diabetes management for nearly 8 years.

Marielle Hampton is a first-year MS candidate in the Agriculture, Food, and Environment program and a co-founder of FFPAC. Marielle began her studies at Friedman after spending five years working with small farmers on Hawai‘i Island.

UN ECOSOC Recap: Building a Sustainable Future

by Laura Barley

In January, second year AFE student Laura Barley served as a student representative to the United Nations Economic and Social Council (ECOSOC) in New York City. Empowered youth from across the globe gathered with governmental officials to share ideas about how to achieve the UN’s 17 Sustainable Development Goals. Here, she recounts her experience and shares some of the key takeaways from the event.

Image source: Author

Image source: Author

For two days at the end of January, I was given the opportunity to travel alongside four fellow Tufts student representatives to the ECOSOC Youth Forum at the United Nations Headquarters in New York. The forum was a whirlwind of speeches, brainstorming sessions, and long-winded discourse from youth representatives and official ministries from all over the world—all putting their heads together to decide how to best empower the future.

ECOSOC, abbreviated from the UN Economic and Social Council, regularly holds these types of events to integrate policy frameworks that support the Sustainable Development Goals from the ground up. For those unfamiliar with the SDGs, they were created by the UN in 2015 as a comprehensive platform of 17 goals that cover the world’s most pressing issues: gender equality, hunger and malnutrition, and climate change mitigation, among many others.

By popular consensus, the SDGs are seen as a much-needed improvement from the UN’s previous set of Millennium Development Goals, which many viewed as too vague and intangible. Instead the SDGs work to define timely, measurable goals that nations can properly mobilize—for instance, reducing current levels of food waste by half, or completely eradicating poverty for people living on less than $1.90 a day.

Fostering the notion that young people have exceptional power to drive social change, the Youth Forum focused specifically on six SDGs that dealt with clean water and sanitation, affordable and clean energy, sustainable cities and communities, sustainable consumption and production, life on land, and technological innovation, and how to empower youth to achieving these goals.

The structure of the forum allowed participants to choose only one SDG-focused brainstorming session, and as the pious AFE student that I am, I naturally gravitated towards the session on SDG 12: Sustainable Consumption and Production. Voices from Great Britain, Nepal, and Saudi Arabia all echoed sentiments familiar to the halls of Jaharis—we’re consuming too much and too quickly for our planet to withstand. We ought to know better by now, but we’re not living up to our own standards as we should be. And under the framework of youth empowerment, the subtext of these truisms begged the question: how can we raise our children to be more mindful than we’ve been?

The voices from developed nations, including my own American perspective, maintained that serious gaps in our educational institutions preclude most youth from even realizing that their choices have an impact on the natural environment. Exposure to nature, agriculture, and nutrition have become secondary and tertiary priorities in most public school systems, which ultimately neglects the chance to positively influence the consumers that all children will become.

So, when it came time to distill our ideas into concrete policy recommendations, we converged on a few points central to the evolution of education. We recommended increasing diverse and equitable educational experiences across all types of school systems, emphasizing focus on transforming the mindsets of youth from those of a consumer towards those of a producer. In this sense, sustainable development means an expanded awareness of the relationship between consumption and production, and that even the simplest of our everyday choices has the power to influence how the world’s natural resources are used.

Image source: Author

Image source: Author

Ultimately, the participants’ recommendations will be compiled into a broader report on youth engagement published by the United Nations, reflecting official policy goals of the signatory countries to the SDGs. And though I gleaned constructive insight into the annals of UN procedure—how they gather information, how they form their policy stances—I found that the hallway conservations I had with my peers were far more valuable. These events function to tap into the infinite potential of minds with vision and hope, and the sum of our parts are starting to become an incredibly powerful whole. Earnestly, I hope to see the Tufts community continue to engage with the Sustainable Development Goals at this level and beyond.

Laura Barley is a second-year Agriculture, Food, and Environment master’s student ceaselessly curious about the complexity that global food systems has to offer. She’s always happy to indulge conversation at laurabarley88@gmail.com.

A Statement of Support to our Colleagues at the Fletcher School

by The Friedman Justice League

The Friedman Justice League responds to Anthony Scaramucci’s resignation from the Advisory Board at the Fletcher School of Law and Diplomacy on November 28, 2017. “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.” – Margaret Mead

By Jdarsie11 (Own work) [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons

By Jdarsie11 (Own work) [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)%5D, via Wikimedia Commons

The Friedman Justice League, with support from the Friedman Sprout, is writing to state its solidarity with the students at the Fletcher School of Law and Diplomacy who bravely spoke out when they felt that a member of the Fletcher Advisory Board was not upholding the school’s core values. As a student organization, The Friedman Justice League is committed to finding ways to allow the Friedman community to better address issues of discrimination and oppression in its teachings, research, and programs. We believe the actions taken by fellow students at the Fletcher school reflect this same mission, and for that we affirm our support.

On November 28, financier and former White House Communications Director Anthony Scaramucci resigned from the Fletcher School’s Advisory Board after students and faculty rightly called attention to the discrepancy between his unethical behavior and the values befitting a Fletcher School board member. Earlier in November, Camilo Caballero, a graduate student at Fletcher, wrote an op-ed calling for Scaramucci’s removal from the board, following a petition by fellow student Carter Banker to remove Scaramucci from the board. In the op-ed, he described Scaramucci as an “irresponsible, inconsistent and unethical opportunist,” questioning his position on the Advisory board. They feared that the university was foregoing the long-term benefit of upholding its core values for the short-term benefit of monetary gain. Clearly, the actions Scaramucci took towards Caballero–to threaten a lawsuit because of our fellow student’s opinion–illustrate that his values may no longer align with those of the school, and thus he was no longer fit to continue serving on the board.

Our colleagues at the Fletcher school held themselves accountable for creating the change they wished to see within their institution. Rather than resigning themselves to defeat, they took action when they perceived an injustice. They took action when they perceived that “the power of money [was] taking precedent over the power of values.” We stand in solidarity with the brave steps taken by Camilo Caballero and Carter Banker.

We recognize that our Fletcher colleagues Caballero, Banker, and the editors and staff at The Tufts Daily published their articles at great personal risk to themselves, and we applaud them for doing so. In a statement on behalf of the Friedman Sprout, current co-editor Kathleen Nay says,Though we hope our writers would never feel intimidated or harassed into silence by outside forces, the Friedman Sprout upholds its commitment to empowering students’ voices, especially when challenging injustices in our school’s administration and in our food system more broadly.”

In keeping with the University’s vision “to be an innovative university of creative scholars…who have a profound impact on one another and the world,” we should be proud of our Fletcher colleagues for demonstrating the power of democratic free speech, civic engagement, and commitment to values over financial gain. We hope that should an occasion ever arise, the community at the Friedman School would respond with the same amount of conviction and integrity these students exemplified. The Friedman School prides itself in generating trusted science, educating future leaders, and creating a positive impact in the world of food and nutrition. We know that this is only truly possible if we have trusted experts and citizens at the helm guiding it in the right direction. Anything short of this would place the credibility of Friedman, and by extension the science and policy its research generates, at risk.

Moving forward, we also believe it is in the best interest of the university to develop a process for removing board members that are no longer fit to advise our school. Executive Director of Public Relations Patrick Collins noted that there is no known precedent for removing an advisor from a board; they have only resigned when new positions create conflicts of interest. Although in this case Scaramucci resigned, we believe that no person should take being placed in such an honorable position for granted, and that as representatives of our institution they should be held to the highest standards of morality both within and outside of board meetings. We hope that the administration will take action to ensure that only those who continue to uphold the university’s values continue to have the privilege of a seat on the Board of Advisors.

With the brave voices of a few, our colleagues at the Fletcher school made national waves and created an impact that we believe makes Tufts University a more just and ethically consistent institution. We reaffirm our support of the actions of our fellow students. They inspire us at Friedman to remember to be vigilant, to speak up, and to never underestimate the power of your own voice.

In solidarity,

The Friedman Justice League
Alejandra Cabrera, NICBC 18
Tessa Salzman, AFE/UEP 18
Julie Kurtz, AFE/MPH 18
Casey Leger, NICBC 18
Yvonne Socolar, AFE 18
Kristin Sukys, AFE 18
John VanderHeide, AFE/UEP 18
Kirsten Archer, FPAN/MPH 17
Kathleen Nay, AFE/UEP 18
Eliza Hallett, NICBC 19
Alyssa Melendez, AFE 19
Hannah Meier, NutComm 18
Michelle Darian, NICBC/MPH 19
Megan Maisano, NICBC 18
Sara Scinto, NICBC 18
Jennifer Oslund, FPAN 19
Sabrina Kerin, AFE, 19
Jennifer Pustz, NICBC/MPH 19
Leah Powley, AFE 18
Michelle Rossi, NICBC/MPH 18
Hattie Brown, FPAN 19
Ryan Nebeker, AFE 19
Eliot Martin, FPAN 19
Maria Wrabel, FPAN, 18
Katherine Rancaño, NEPI 17/NICBC 20
Rachel Baer, NICBC 18
Madeline Bennett, FPAN 17
Alana Davidson, FPAN 19
Simon Ye, BMN 17/20
Jessica Manly, AFE 18
Caitlin Matthews, AFE/UEP 17
Amy Byrne, AFE/MPH 19
Ayten Salahi, FPAN/DPD 20
Theodore Fitopoulos, FPAN 18
Kimberly Lagasse, NICBC 18
Rachel Hoh, AFE/ UEP 19
Molly Knudsen, NICBC 19
Victoria Chase, AFE 18
Caitlin Bailey, NICBC 19
Sarah Chang, AFE/MPH 16
Suzanne Kline, FPAN 19
Carla Curle, AFE 16
Hannah Packman, AFE 16
Dianna Bartone, FPAN/MPH 17
Elisabeth Learned, NICBC 19
Bridget Gayer, FPAN/MPH 18
Abel Sandoval, NICBC 18
Rebecca Cohen, BMN 19
Nayla Bezares, AFE 19
Sabina C Robillard, FPAN 17
Laura Gallagher, AFE 19
Natalie Kaner, AFE 18
Lindsay Margolis, NICBC 17
Tori Wong, AFE 18
Megan Lehnerd, N14/PhD 18
Laura Walsh, NICBC 19
Alison Brown, FPAN 17
Marielle Hampton, AFE 19
Christine Sinclair, NICBC 19
Rebecca Boehm, AFE 12/17
Johanna Andrews Trevino, FPAN 18

How Nutrition in MassCare May Put The ‘Health’ Back in ‘Universal Health Coverage’

by Ayten Salahi & Hattie Brown

Including local incentives for food equity and nutritional status may boost momentum and potential of the MA Right to Health movement. Members of budding student group – the Friedman Food Policy Action Council (FFPAC) – met with Massachusetts State Senator Jamie Eldridge to discuss the need to include nutrition in a proposed cost analysis of a single payer health system (S.2202).

Pictured left to right: Ayten Salahi (MS/RD Candidate), Kurt Hager (MS/MPH Candidate), Senator Jamie Eldridge, Alana Davidson (MS Candidate). 22 NOV 2017

In thousands of American households, the prohibitive cost of healthcare has forced families into an impossible position: choose between financial ruin or the health decline and possible death of a loved one. In Massachusetts, this bleak reality has motivated both the state legislature and its constituents to revive a movement in favor of a single payer healthcare system. However, the degree to which nutrition interventions and food access will be covered in the proposed model remains largely unknown.

The central tenet of a single payer scheme under universal health coverage (UHC) is that health care is a human right. The proposed legislation in Massachusetts seeks to offer and protect healthcare for all residents through a publicly-financed program that provides comprehensive care and coverage under a single insurance plan. The single payer public option would serve as an alternative to employer-sponsored healthcare, in which premiums are paid through payroll deductions, coupled with co-pays and out-of-pocket deductibles. For middle- and lower-income beneficiaries, a single payer system means lower cost for better access to care.

In Massachusetts, the single-payer campaign has reached unprecedented support with 120 co-signers under a 2017 proposal colloquially called MassCare (H. 2987, S. 619). Though neither of the proposed legislation were passed this year, an amended bill (S. 2202) was passed with overwhelming support by the state Senate on November 10 by a 33-6 vote (all six Republicans in the chamber being against). S.2202 authorizes a cost analysis of a state-wide single payer system, and will be reviewed by the House in early 2018.

While MassCare holds promising potential to reduce healthcare spending for both the state and per capita, the proposed legislation does not explicitly or implicitly include nutrition interventions as a line item for consideration in the single payer costing analysis. Historically, UHC policy-makers have deemed nutrition-related services as non-essential, and therefore not covered by insurance. The World Bank refutes this trend, and reports that to accelerate progress towards affordability and access of care requires a “fundamental rethinking of how to keep people healthy.” The recommendations go on to cite regulatory measures targeted to improve diet-related behavior as seminal to the public health agenda. Just last year, the International Food Policy Research Institute (IFRI) further urged policy-makers to include access to adequate nutrients as an essential service in all UHC programs.

To learn more about how nutrition might fit into the proposed single payer costing analysis, three members of the nascent, student-run Friedman Food Policy Action Council (FFPAC) took to the Massachusetts State House in late November to meet with single payer champion and state Senator Jamie Eldridge. FFPAC emphasized that, as Massachusetts prepares to analyze the cost effectiveness of single payer models as outlined in S.2202, additional resources should be allocated to determine the efficacy of funding nutrition therapy programs within the model. To achieve this, FFPAC proposed that the MA single payer costing analysis include: 1) medical nutrition therapy coverage for patients with, or at risk for, hypertension, obesity and cardiovascular disease (CVD); 2) enteral nutrition coverage as outlined in MassHealth; 3) food insecurity screenings for all patients; and 4) tailored food prescriptions for low-income patients.

State Senator Jamie Eldridge, lead Senate sponsor of An Act Establishing Medicare For All in Massachusetts, said, “I was excited to meet with graduate students from the Friedman School of Nutrition, to discuss how preventative health, including nutrition interventions, would be a key component of single payer healthcare, and would help reduce healthcare costs in Massachusetts.”

As the proposed bill continues to undergo revision and review into 2018, FFPAC will continue to advocate that Massachusetts – home of the healthcare law that led to the Affordable Care Act –should again lead by investing in nutritional therapy programs in a single payer model as a method to improve the health of its citizens, lower healthcare costs, and lower the tax burdens of its residents.

The Friedman Food Policy Action Council (FFPAC) is a developing student-run organization of the Friedman School of Nutrition Science and Policy at Tufts University. The group will be formally established in December 2017, with a mission to advance evidence-based nutrition and agricultural policies in support of public and environmental health, by equipping students with the skills and relationships necessary to impact policy through advocacy. FFPAC will host its general interest meeting in the early 2018. For further information, please contact friedmanfpac@googlegroups.com. Stay tuned for opportunities to join us and amplify the voice of food advocates in 2018!

Ayten Salahi is a first-year FPAN MS/RD candidate, co-founder of the FFPAC, and is dedicated to the future of policy, programming, and clinical practice in sustainable diets. Ayten came to Friedman after working as a molecular and clinical researcher in neuropharmacology and diabetes management for nearly 8 years.

Hattie Brown is an MS candidate in the FPAN program, and a co-founder of FFPAC. Her interests at Friedman are in the economic implications of food systems, with a focus on the intersection of sustainable agriculture and access to nutritious food. Before coming to Friedman, Hattie worked as a researcher in various capacities, including legal, for a public finance firm, and clinical, for a study analyzing phytochemical compounds in cocoa and their impacts on satiety.